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Insurance company faces backlash for coverage changes

On Behalf of | May 14, 2018 | Insurance Defense

A trip to a New York emergency room used to be a cause of great anxiety. Rushing a child or a loved one to the ER typically meant his or her health was in serious or grave danger. In recent years, however, with the cost of health care and insurance ever rising, more people seem to be choosing the emergency room as a replacement for a primary care giver or for after-hours care. Because of this, one insurance company has changed its policy regarding coverage of emergency room visits.

Anthem, the parent company of Blue Cross Blue Shield, is looking for ways to keep its costs down and, subsequently, the costs for their customers. One step the company hopes will make a difference is reducing the types of treatment it will cover for emergency room visits. While the company urges its customers to seek medical care without delay if they have emergencies, the move results from an expensive misuse of ER services. Many problems seen by ER doctors may be addressed in urgent care or with a family doctor.

Physicians have banded together to protest the changes. They claim only about 10 percent of their patients are using the ER for the wrong reasons. Doctors are concerned that patients will refuse to seek emergency medical treatment for fear the insurance company will deny their claims. However, Anthem assures patients they can appeal any claim the company denies, especially since the company is currently adding to the list of medical procedures it will accept in an emergency room visit.

Even with the numerous options now available to New York patients, such as urgent care and after-hours clinics, insurance providers continue to suffer financially when ER services are abused. While it is possible that patients may file a legal claim against an insurance company that denies coverage for a medical procedure, the insurer is within its rights to refuse to pay for services that fall outside the limits of a policy. An attorney can provide representation for an insurer facing such a legal challenge.

Source: wbrc.com, “Patients outraged by Anthem ER visit policy change“, Hayley Mason, May 8, 2018