Anthem's effort to punish patients for 'unnecessary' ER visits has been a bust — but still burdens patients
In the last few years, Anthem Blue Cross has made a strong bid for the award for the most heartless and senseless coverage policy in the health insurance business.
Its competition entry is a policy that penalizes patients for seeking "unnecessary" treatment at an emergency room. If Anthem concludes that the reason for the visit wasn't an emergency after all, it can deny the claim - saddling members with bills that could exceed $10,000.
Anthem's rationale is that the ER is the costliest venue for medical treatment; therefore, weeding out patients whose medical complaints could more appropriately be managed through a doctor's appointment or a visit to an urgent-care clinic will save money for Anthem and for its customers base. Anthem launched this program in Kentucky in 2015 and expanded it in 2017 and this year to Indiana, Georgia, Missouri and Ohio. (The company dropped plans to expand it this year into New Hampshire.)
Now, after several years' experience in some of
