Doctors and Patients Push Back on Insurer Not Paying for E.R. Visits

The New York Times reports that health insurer Anthem was refusing to pay for emergency room visits that are not needed “right away to avoid a serious risk to health.”

To rein in emergency medicine costs, Anthem is reviving an old, contentious tactic: pushing back on patients who visit the emergency room for ailments deemed minor.

Anthem denied thousands of claims last year under its “avoidable E.R. program,” according to a sample of emergency room bills analyzed by the American College of Emergency Physicians. The program, which Anthem has been rolling out in a handful of states in recent years, reviews claims based on the final diagnosis of patients.

Emergency room physicians say that, last year, the company did not routinely request medical records for denied patients, and therefore could not review the symptoms that brought them to the emergency room. Anthem says it is now reviewing such records before issuing denials.

But patients and doctors have been pushing back in the form of opinion pieces, lobbying and even humorous videos ridiculing the idea that people can be their own doctors and know when not to go to an emergency room.

The criticism seems to have had an effect: For now, Anthem appears to be denying fewer claims — though it also expanded its policy to several more states.

Data shows how emergency room bills that were unpaid by Anthem surged last year but have now reversed as Anthem changed its’s policy in the face of pressure from doctors and patients.

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