Anthem tells patients: “save the ER for emergencies — or you’ll be responsible for the cost!”

Jonathan Heidt learned about Anthem’s new policy last June. He’s the president of the Missouri chapter of the American College of Emergency Physicians and was at the group’s monthly meeting when Anthem representatives came in to make a presentation.

“Anthem came to the state chapter and told us they had a new policy they were getting ready to roll out,” Heidt said. “At the time when we met with them, they said they had a significant number of patients who were going to the ER for conditions that could be seen in other, lower-cost settings.”

The Anthem denial policy would not cover “non-emergent ailments” seen in the emergency room. It would, however, exempt patients younger than 15, visits that occur over the weekend, and visits from patients who live 15 miles or farther from an urgent care center.

“For non-emergency ailments, ERs are an expensive — in many instances 10 times higher in cost than urgent care — and time-consuming place to receive care,” Anthem said in its statement to explain the policy. “Treating these non-emergency ailments in ERs increases the cost of healthcare for consumers and the healthcare system as a whole.”

A month earlier, in May 2017, Anthem had sent a letter to its thousands of Missouri members warning of the change.

“Save the ER for emergencies — or you’ll be responsible for the cost,” the letter, first reported by St. Louis Public radio, stated in big blue letters. “Starting June 1, 2017, you’ll be responsible for ER costs when it’s NOT an emergency.”

A letter from Anthem to Missouri members in May 2017. St. Louis Public Radio

The letter suggested going to an urgent care center for “back and joint pain” and visiting a retail clinic for “minor allergic reactions, bumps, cuts & scrapes.” It also advertised Anthem’s own online doctor visits and 24/7 nurse hotline.

Emergency room doctors started to notice the change quickly. Heidt, who attended the summer meeting, says that his hospital “was receiving denials within days. We discussed that with [Anthem]. They said they were thinking of looking at medical records, but all of the denials at that point were coming off the claims.”

An Anthem spokesperson said that the health plan uses both diagnostic codes as well as medical records in their review process.

Anthem’s policy appears to be targeted toward pushing patients not to go to the emergency room when they have an injury or illness that could be treated elsewhere. That can hold down premiums in recent years.Premiums for everyone has risen, as emergency room visits are expensive — and, as prices in emergency rooms have increased rapidly

Leave a comment

Your email address will not be published. Required fields are marked *