WASHINGTON, D.C.—Missouri patients are still at risk from Anthem’s policy to deny coverage for emergency patients, despite increasing the number of “always pay” exceptions and an acknowledgment that coverage should be based on symptoms, not final diagnosis, a standard that is part of federal law, according to the American College of Emergency Physicians (ACEP). In response to Anthem’s policy changes in Missouri, Paul Kivela, MD, MBA, FACEP, president of ACEP, released the following statement:
“The changes to Anthem’s policy in Missouri do not address the underlying problem of putting patients in a potentially dangerous position of having to decide whether their symptoms are medical emergencies or not before they seek emergency care, or pay the entire bill if it’s not an emergency. The additional always-pay exceptions, such as patients who receive surgery, IV fluids or IV medications, MRI or CT scans, or hospital admission, should have always been exceptions.
“Patients should not be forced to diagnose themselves out of fear their insurer won’t pay. Most patients can’t be expected to determine, for example, the difference between abdominal pain that is life-threatening and abdominal pain that isn’t. It’s impossible for a patient to know before going to the emergency room whether they’ll receive there the IV fluids, MRI, or surgery needed to ensure their visit will be covered. The decision to ‘ride it out’ instead of seeking emergency care could lead to life-long disability or even death.
“In addition, Anthem’s denials process still leaves patients on the hook financially, which could be crippling or credit-destructive, even for employed individuals. Insurance company reviews can take months, leaving patients with expenses they should not have been asked to pay.”
Beginning in mid-2017, Anthem BCBS began warning patients first in Missouri, Georgia, and Kentucky, and then Ohio, New Hampshire and Indiana, that if the ER visit ends with a diagnosis for something that isn’t an emergency, that visit will not be covered by insurance.