June 10, 2017
Living with a chronic illness or disability often means frequent trips to the emergency room, especially during severe flare-ups or late-night health scares when your regular doctor isn’t available. But what exactly qualifies as an emergency, and who gets to make that determination?
For Anthem Blue Cross/Blue Shield members residing in Georgia, Missouri, or Kentucky, a new policy set to take effect on July 1, 2017, may impact your choices regarding ER visits. As reported by NBC News, if a visit is deemed a non-emergency, members will be liable for the costs associated with their treatment.
“Reserve the ER for true emergencies—or be prepared to cover the expenses,” reads a letter sent to Blue Cross/Blue Shield of Georgia members, which NBC News acquired. “As of July 1, 2017, if it’s NOT an emergency, you’re on the hook for those ER costs. This helps ensure the ER is available for those genuinely in need.”
Anthem’s definition of an emergency includes a variety of serious medical or behavioral health situations, such as severe pain or conditions that could endanger the patient’s health or that of others, including pregnant women. Examples cited include chest pain, strokes, poisoning, and severe bleeding.
An Anthem spokesperson clarified that the policy aims to prevent misuse of emergency services, emphasizing the importance of seeing a primary care physician first. However, the final call on whether a visit is classified as an emergency rests with the insurance company, potentially leaving patients responsible for their bills if deemed otherwise.
Interestingly, children under 14, visits on Sundays or holidays, and those lacking access to nearby urgent care centers (more than 15 miles away) will be exempt from the charges, according to a representative from Anthem in Georgia. This policy aims to encourage patients to utilize telemedicine and urgent care instead of the ER.
The American College of Emergency Physicians (ACEP) has criticized this new approach, asserting that it contradicts the ‘prudent layperson’ standard established by federal law, including the Affordable Care Act, which is upheld in over 30 states. They argue that making patients pay for non-emergency visits undermines the purpose of emergency care. Dr. Rebecca Parker, president of ACEP, stated, “If patients believe they are experiencing a medical emergency, they should seek immediate assistance. The majority of emergency patients act appropriately, according to the CDC. Self-diagnosis should not be expected of patients, which is why the prudent layperson standard must remain in any healthcare legislation.”
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In summary, Anthem Blue Cross/Blue Shield’s new ER policy raises concerns about patient care and self-diagnosis, as the determination of ’emergency’ now lies with the insurance company. This could lead to unexpected costs for members who believe they are experiencing a genuine medical emergency but are later deemed non-emergency cases by the insurer.
Keyphrase: Anthem Blue Cross Blue Shield ER Charges
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