One out of every six patients who visit an emergency room could see denied claims—and a whopping hospital bill—if a retrospective review policy imposed by Anthem not long ago were adopted by other insurers. A study just published in JAMA Network found that 15.7% of ED visits by commercially insured adults could result in denial of the claim on the grounds that presenting symptoms were found to be nonemergent after the fact. The researchers considered ED visits from the National Hospital Ambulatory Medical Care Survey between 2011 and 2015. The healthcare spending implications of that could be staggering, and the policy has already drawn the ire of hospital groups and patients. However, the silver lining could be a prime marketing opportunity for urgent care centers in states where the Anthem policy is in effect. With the onus on patients to decide if their symptoms are truly emergent, many may (and should) opt to avoid the ED. Urgent care is likely to be the best option for those patients in any state, but in Georgia, Kentucky, and Missouri the price could be a major consideration. Adapt your marketing approach to clarify the level of care available in your urgent care centers—and the fact that claims are less unlikely to be denied than if they visit the ED in those states.
Anthem Policy Should Direct More Patients to Urgent Cares—if You Seize the Opportunity