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Anthem keeps people from getting ER care simply by claiming it may not pay for it

Written by Diane Archer

The New York Times has a follow-up story on Anthem, the insurer that unconscionably denied some of its enrollees coverage for emergency care if it did not believe their diagnosis warranted it. According to a new congressional report, Anthem has reversed its policy. Still, Anthem likely has deterred its enrollees from seeking ER care.

In 2017, Anthem denied coverage for more than 12,000 emergency room visits, stating that they were unnecessary and “avoidable.” However, the patients who appealed Anthem’s denials were successful in most cases. The benefit to Anthem is that most people do not know they can challenge an appeal and that it can be worth it to do so. So, they ended up stuck paying ER bills that they likely should not have had to pay.

Anthem says it has now changed its policy, limiting its denials for ER visits. And, there is some evidence that it is now approving ER care in most instances. But, there is also a fear that its enrollees are worried about being denied coverage for their ER visits and not seeking ER care when they need it.

Anthem has been sued by doctors’ groups, who allege that Anthem violated the law with its ER policy since it forced patients to determine whether they needed ER care when they did not know their diagnoses. Let’s get real. People generally do not know whether they are having a heart attack or heartburn.

Anthem says that it is simply trying to keep its costs down since ER care is so expensive. Of course, the less it spends on care, the more profits it makes. Rather than penalizing patients who think they need ER care because ER costs are so high, Anthem should be arguing for Medicare for all, which would include rational prices for care.

Congress, for its part, should step in and support Medicare for All. Senators and House members should recognize that commercial insurers are unable or unwilling to rein in excessive and unsustainable provider costs. Instead, they shift responsibility onto their enrollees

If you support Medicare for all, please sign this petition.

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1 Comment

  • While Anthem claims they have mended their ways the fact remains that the primary focus of any publicly traded stock company is to maximize profits for its share holders. Providing healthcare to its subscribers is secondary.

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