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Growing Number of Major Health Insurers Implementing Emergency Room Denial Policies

Insurance and Healthcare Denials
Growing Number of Major Health Insurers Implementing Emergency Room Denial Policies

Health insurers are starting to implement policies that would deny coverage for emergency room visits deemed ‘non-emergencies.’ These new type of policies were purportedly created to combat the rising number of emergency room visits for non-emergency situations. The most notable insurer partaking in this policy, Anthem Insurance, believes that by sending denial letters to customers following an emergency room visit, it will discourage other patients from going to the emergency room for less serious ailments. The policy started in Kentucky in 2015 and spread to Missouri, Georgia, Indiana, Ohio, and New Hampshire in 2017. The policy is not yet implemented in Los Angeles or any other part of California.

States such as Indiana and Kentucky are following private insurers and are implementing similar policies with Medicaid enrollees. The rise in this health insurance practice is pushing patients to assess their own medical condition, which is very dangerous, or pay thousands out of pocket.

In a statement, Anthem said that the purpose of the policy is to maintain high-quality health care for those who come into an emergency room, and moving non-emergency cases into the most appropriate setting. Anthem, one of the largest private health insurance providers in the United States, claims that more than a quarter of trips to the emergency room could be treated at a doctor’s office or retail health clinic instead of an emergency department. While this may be true, hindsight is twenty/twenty.

Consumer advocacy groups, such as the American Heart Association, say that these policies could prevent patients from seeking the medical care they may need for life-threatening emergencies. The denial policy Anthem uses comes with a list of exceptions, such as the company will pay for emergency room visits for patients younger than 15, when a customer is traveling out of state, or if the medical event takes place over the weekend or a holiday.

Critics to the policy believe that the emergency department is there to diagnose unknown ailments in an expedited manner. Expecting an untrained individual to gauge the severity of their own symptoms, could lead to illness, disability, or even death.

If you or a family member has encountered problems with a health insurance company refusing to pay for an emergency room visit or other necessary medical procedure, contact the Law Offices of Scott Glovsky. Our team of knowledgeable attorneys could help assess your situation and support you in appealing a health insurers denial claim.