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Doctors group speaks out against health insurer’s policy denying coverage of some ER visits



A major health insurance provider in Missouri is taking heat from a group of doctors. The American College of Emergency Physicians claims Anthem Blue Cross Blue Shield is warning members they may have to pay for trips to the emergency room.

The organization says Anthem has developed a secret list of diagnoses it will not pay for, even if a patient thought the condition was a medical emergency.

The American College of Emergency Physicians, or ACEP, contends the insurance company is violating the “prudent layperson” standard, which states that an insurer must offer coverage based on a member’s symptoms, not on the final diagnosis. The standard also states that insurers cannot require a member to get prior medical authorization for coverage of emergency department services.

National ACEP President, Dr. Rebecca Parker, contends Anthem is wrongly placing the burden on patients to determine whether their conditions are serious or not.    “It is not fair for health insurers to expect patients to know the difference between a heart attack and something that is not life threatening,” said Parker.

Heidt says if patients have to cover emergency rooms costs once, they’re likely to put off subsequent visits which could compound their health problems.

Anthem claims it is simply trying to address member concerns that it’s paying for recipients who are driving up costs with unnecessary ER visits.

Read more: Missourinet

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