Punishing Patients?

Think you need to go the ER? Patients in several states are finding out the hard way that one of the nation’s largest insurers won’t cover the ER visit if the company decides it wasn’t really an emergency.

From the Los Angeles Times:

Over the last few months, Anthem, the nation’s biggest health insurer, has informed customers in several states that if they show up at the emergency room with a problem that later is deemed to have not been an emergency, their ER claim won’t be paid.

The policy has generated protests from numerous physician groups, including ER doctors, as well as pointed questions on Capitol Hill and among state regulators. So Anthem has taken the obvious next step: This year, it’s rolling out the policy in three additional states. Prior to Jan. 1, the policy was in effect in Georgia, Missouri and Kentucky. This year, it’s adding New Hampshire, Indiana and Ohio. More states may follow.

Medical experts say the policy places an insupportable responsibility on ordinary customers to diagnose themselves before turning to the ER for treatment.

According to Vox.com, “The problem: These denials are made after patients visit the ER, sometimes based on the diagnosis after seeing a doctor, not on the symptoms that sent them.

The American College of Emergency Physicians put together a short video slamming the decision to force patients to decide if what they are experiencing is indeed an emergency. You can watch it by clicking here or on the picture below.


Yahoo News wrote:

The company insists that the program is aimed at providing its members with the best care possible and keeping them from spending long hours in ER waiting rooms. But patient advocates say the move is a thinly veiled attempt to reap more profits, one that’s putting patients’ lives in danger.

And Philly.com added, “What this means is that patients are somehow supposed to assess their own medical condition — to self-diagnose their own problems — before they see a doctor.”

We’d love to hear your thoughts on Anthem’s decision to stop covering non-emergency visits in some states. Do you believe it puts too much pressure on patients to decide if what they are experiencing is a true emergency? Driving these types of conversations around the health stories making headlines is another way we are working toward our long-term goal of one day making Arizona the Healthiest State in the Nation!

One thought on “Punishing Patients?

  1. Given my experiences, I’d say it’s a good and needed policy, though one with some negative side effects. Too many people use the ER as a “walk in clinic” or in place of a doctor’s visit.


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