If Anthem Blue Cross Blue Shield decides your visit to the ER was not an emergency, based largely on their undisclosed list of diagnoses, they’ll leave you with the entire bill. It retroactively denies coverage for emergency patients.
The American College of Emergency Physicians has two new videos to point out the dangers of the insurance giant’s controversial and hazardous emergency care policy.
To see the videos, go to www.FairCoverage.org
“Countless symptoms can either be something minor or something life-threatening,” said Dr. Paul Kivela. “We can’t possibly expect people with no medical expertise to know the difference between the two before they even leave their house. Anthem is forcing them to play doctor and threatening them financially if they go to the ER.”
Emergency physicians are urging the public to contact state and federal legislators and regulators and demand that health insurers provide fair payment for emergency services or emergency patients will suffer.
The videos focus on two scenarios. One shows a man with stomach pain looking up possible causes on the internet. His wife advises him to go to the ER, but he refuses, saying “if it ends up being just a hernia or really bad stomach pain, our Anthem insurance won’t cover us.”
The second has a man in a gym with chest pain. A concerned employee offers to take him to the ER but he refuses, saying “if it turns out to just be injured ribs, Anthem could deny my claim and send me the ER bill.”
“These videos demonstrate what millions of people go through every day trying to determine what is an emergency and what is not and hoping they make the right choice,” said Kivela.
“Anthem’s policy is unlawful. The ‘prudent layperson standard’ is federal law that requires health insurance companies to cover emergencies visits based on the patient’s symptoms, not the final diagnoses. No insurance policy is affordable if it abandons you in an emergency.”
Anthem has rolled out this policy in six states: Georgia, Kentucky, Indiana, Missouri, New Hampshire and Ohio. Unless stopped, this could go into effect in more Anthem states, with other insurance companies possibly following with policies of their own.
Go to www.FairCoverage.org and learn more. If you live in one of the affected states and have a story to share about how your insurance coverage was denied for an emergency, let us know.