Insurer doesn't want to pay for non-emergency ER visits

WCPOPublished: October 25, 2017
Published: October 25, 2017

Being rushed to the emergency room can be a scary thing, especially for anyone who doesn't know what's wrong. Some patients have gotten another scare: a bill for the cost of the visit that wasn't covered by insurance. That's because of a major policy change that has some health care providers worried. The general expectation is that insurance will cover costs for emergency medical issues, Dr. Ryan Stanton, spokesperson for the American College of Emergency Physicians, said. But Anthem Blue Cross and Blue Shield has a policy denying some emergency room claims if they believe the visits weren't actual emergencies. In a statement, the company said they believe primary care doctors are the first medical professional patients should see for non-emergency medical concerns.  There's also a cost issue. The average cost of an ER visit is about 10 times the cost of a visit to a primary care doctor, urgent care or retail clinic, according to Anthem.  The company also said patients visiting the ER with non-emergency issues could end up waiting for hours as more serious cases are treated first.  "Despite education campaigns to inform the public about the risks and costs of going to the ER for non-emergent care, inappropriate use of emergency rooms continues to be a problem," a company spokesperson wrote. Bill Banks, the vice president of managed care for St. Elizabeth Healthcare, said both patients and hospitals can appeal an insurance company's decision to not cover an emergency room visit. "The bigger concern is, it's going to keep out some people that really need to be in the emergency room," Stanton said. "And we're trying to attack this before people get hurt and die." The policy is already in place in several states, including Kentucky and Indiana. Anthem said it's set to take effect in Ohio in January.

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