WASHINGTON – Anthem Inc. today announced a strong financial performance in their second quarter earnings call, despite recently issuing a new policy that would force customers in certain states to pay for their own emergency department bills if the company determines the event was not an actual emergency. Consumers for Quality Care (CQC) spoke out against Anthem’s policy, which took effect earlier this month in four states, and protects profits over consumers, even if a patient goes to an in-network hospital. In response to the news that Anthem Inc. is sacrificing consumer health for cost savings despite the fact they are already making a profit, CQC issued the following statement:

“While Anthem touted increased revenue, its customers in Missouri, New York, Georgia and Kentucky are facing the very real concern that they may not be protected from huge hospital bills when visiting the emergency room — just so their insurance company can save money at their expense. Policy-holders in these states are in an incredibly unfair situation, too often forced to act as their own doctor to avoid surprise bills.

“During the earnings call, Anthem Inc. Chairman and CEO Joseph Swedish said the company is committed to ‘improving the quality and affordability of health care for our customers,’ and ‘limiting abuses in today’s marketplace.’ This is clearly far from the truth. Their new emergency policy is an abuse that will only lead to more costs, higher risks and less confidence in health care delivery for consumers, all while putting hospitals and providers in an impossible situation.

“In 2015, 13 percent of adults reported delaying or going without health care due to costs, and this will only increase if insurance companies continue to enact policies that prevent consumers from accessing the quality care they depend on and pay for. Anthem, Inc. should remember that policy-holders are the most important stakeholders when it comes to health care decisions and reconsider its strategy of increasing profits regardless of the cost to consumers.”

CQC is led by a board of directors that includes the Honorable Donna Christensen, physician and former Member of Congress; Jim Manley, former senior advisor to Senators Harry Reid and Edward Kennedy; Scott Mulhauser, visiting fellow at The University of Pennsylvania and former senior advisor to the Senate Finance Committee and Vice President Joe Biden; and Jason Resendez, Executive Director of the LatinosAgainstAlzheimer’s Network and Coalition.

Read the letter below:

June 27, 2017

Superintendent Maria T. Vullo
New York State Department of Financial Services
One State Street
New York, NY 10004-1511

Director Chlora Lindley-Myers
Missouri Department of Insurance
P.O Box 690 Jefferson City, MO 65102-0690

Commissioner Nancy G. Atkins
Kentucky Department of Insurance
P.O Box 517 Frankfort, KY 40602-0517

Commissioner Ralph T. Hudgens
Georgia Office of Insurance and Safety Fire Commissioner
Two Martin Luther King Jr. Dr. West Tower, Suite 704
Atlanta, GA 30334

Dear Superintendent Vullo, Director Lindley-Myers, Commissioner Atkins, and Commissioner Hudgens,

As you are likely aware, Anthem Blue Cross/Blue Shield has started informing members in your state that if they utilize emergency department services for a situation later determined by the insurance company not to be an emergency, the patient will be forced to cover the cost. As an organization representing patients in the health care debate, Consumers for Quality Care (CQC) is working to shine a light on issues impacting patient care.

We are writing you today because we know that you share our desire to protect patients. We believe this not only violates the basic tenants of the insurer/patient agreement but this is yet another example of abusive practices that prevents Americans from accessing quality health care.

Increasingly, consumers face fine print that can deny health care services and bankrupt their families. From surprise insurance gaps to unbearable out-of-pocket costs for care and prescription drugs, to impossibly small coverage networks and formularies, there are significant issues that need to be resolved to truly protect patients. This recent development is only the latest obstacle patients now face, and there are numerous issues with the practice.

In an emergency situation, patients with Anthem Blue Cross/Blue Shield will too often be forced to be their own doctor, evaluating whether their head pain is a simple headache or a stroke, or if the nausea they’re suffering is only gas or if it is a heart attack. Making health care decisions in a non-emergency situation can be trying enough. Making them in a split-second is an even greater challenge.

In fact, a 2013 study in JAMA found an 88.7 percent overlap in complaints or symptoms experienced during emergency and non-emergency situations. Under this new policy, a patient wondering if they’re having a stroke, heart attack or other life-threatening condition could forgo treatment to avoid potentially having to pay for the treatment, despite having health insurance coverage.

According to the Kaiser Family Foundation’s analysis of the National Health Interview Survey, 13 percent of adults reported delaying or going without health care due to costs in 2015. This will likely increase now that patients run the risk of getting a surprise medical bill after an insurance company decides their situation wasn’t truly an emergency.

Like you, our concern is first and foremost for patients, who are too often ignored in the health care debate and, as a result, face increasing barriers to quality care. We firmly believe the steps Anthem Blue Cross/Blue Shield is taking will only lead to more costs, greater risks, and less confidence in the health care delivery system for consumers. We also recognize that it puts hospitals and providers in an untenable position. When a patient is taken to a hospital covered under their insurance only to receive a bill from that hospital after their claim is subsequently denied, they’ll look to providers, hospitals and officials like you  with questions and outrage. We are asking that you reject this new policy from going into effect in your state and to do everything in your power to push back against Anthem Blue Cross/Blue Shield.

If you have any questions about this practice or about how CQC can assist, please don’t hesitate to contact us.

Thank you,

Consumers for Quality Care Board Members
Hon. Donna M. Christensen
Jim Manley
Scott Mulhauser

CC: National Association of Insurance Commissioners