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Anthem Faces Additional Criticism Over ER Policy

By Steven Porter  
   February 22, 2018

Lawmakers in Ohio are calling for the insurer to be penalized for a policy that would deny claims for emergency department visits that Anthem deems to be non-emergencies.

Anthem BlueCross BlueShield is facing more criticism over its policy to deny coverage for emergency department visits that the company deems to be for non-emergency situations.

Three state lawmakers in Ohio say they plan to draft legislation to penalize any insurer that implements a policy like Anthem’s, by excluding such insurers from tax breaks and contracts to cover government workers. 

“We will not stand idly to the side and see the changes and the company taking advantage of individuals and putting them at financial risk and, more importantly, putting their lives at risk,” state Rep. Stephanie Howse, D-Cleveland, told reporters during a press conference Wednesday alongside state Rep. Alicia Reece, D-Cincinnati, and state Rep. Thomas West, D-Canton, as The Columbus Dispatch reported.

Related: Patients Will Die From Anthem's Policy Denying ER Payments, Doctor Says

The trio said they would also ask Attorney General Mike DeWine to investigate whether Anthem’s policy complies with all relevant Ohio laws, the Dispatch reported.

The lawmakers aren’t the only voices warning that Anthem’s policy could put patients at risk. Ryan Stanton, MD, an emergency medicine physician and CEO of Everyday Medicine in Lexington, Kentucky, told HealthLeaders Media last month that Anthem is unlikely to change its policy “until somebody dies and they get sued.”

Anthem has said that this policy would come into play only for egregious cases in which an emergency visit was clearly unnecessary.

“Anthem’s ER program aims to reduce the trend in recent years of inappropriate use of ERs for non-emergencies,” the company’s Ohio-based spokesperson, Jeff Blunt, told the Dispatch in a statement. “For non-emergency health-care needs, ERs are often a time-consuming place to receive care and in many instances 10 times higher in cost than urgent care.”

Steven Porter is editor at HealthLeaders.

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