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Anthem rolled out a new policy holding patients directly responsible for the ER bill if it is later deemed non-emergent. And who will decide whether the visit was emergent or not? You guessed right.

Anthem’s policy is in place in Georgia, Kentucky, and Missouri. Next up is Indiana.

Anthem just sent notice to enrollees in Missouri stating “Save the ER for emergencies – or you’ll be responsible for the cost.”

The notice continued:

“Going to the emergency room or calling 9-1-1 is always the way to go when it’s an emergency. And we’ve got you covered for those situations. But starting June 1, 2018, you’ll be responsible for ER costs when it’s NOT an emergency (this isn’t a change to your benefits plan).”

The AMA asked Anthem to rescind the policy in states where it has been put into effect. The AMA also asked that it not be implemented in any other states.

The AMA and American College Emergency Physicians argue the new policy might violate the “prudent layperson standard” codified into state and federal law. The standard defines an emergency medical condition as one that manifests itself “by acute symptoms of sufficient severity” that a prudent layperson could reasonably expect that the absence of immediate medical attention could place their health in serious jeopardy. 

Anthem counters this is much ado about little. The first state the policy was implemented in was Kentucky in late 2015. They note that only 1% of ER claims have been denied for being an avoidable visit. But, this stat does not include patients who may have avoided going to the ER in the first place for a bona fide emergency.

Asking patients to second guess an emergency is wrong. Patients should be able to err on the side of caution and not have to choose between their life and a giant unexpected bill.

What do you think? Use the comment box below to share your thoughts. 


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