When Anthem announced some months ago it would not cover bills for “unnecessary” (in their retrospective view) trips to the emergency room in some states, we noted objections from physician groups. Now that the policy is in place and claims for 2018 have started to be filed, we’re seeing media reports on angry patients who are getting stuck with bills they presumed would be covered. Consumer Reports, for one, recounts the case of a patient who went to the ED because she thought she could be having a stroke. Her relief that her symptoms were actually being caused by a severe inner ear infection turned to outrage when she got a letter from Anthem informing her that the bill—$4,300—would be hers to pay because her eventual diagnosis was not among those covered by her plan. Further, it not-so-helpfully explained that she should have called Anthem’s 24-hour doctor service instead of taking it upon herself to go to the hospital. Anthem ended up reimbursing the patient after she went through a lengthy appeal process, but Consumer Reports quotes her as saying she’d be more hesitant to go to the ED next time—which is the very thing that concerned physicians about the policy from the outset. It was first implemented in Kentucky, and has been expanded to Georgia, Missouri, Indiana, New Hampshire, and Ohio. The only silver lining may be that the policy encourages patients to go to an urgent care center for many of the complaints it will decline to cover.
Anthem ED Policy is Starting to Rankle Patients