In recent developments affecting individuals with chronic illnesses or disabilities, Anthem Blue Cross/Blue Shield has announced a new policy that could significantly impact ER visits for its members in Georgia, Missouri, and Kentucky. As reported by NBC News, beginning July 1, Anthem members will be responsible for the expenses incurred during emergency room visits that are classified as ‘non-emergencies.’
In a communication directed to Blue Cross/Blue Shield of Georgia members, the insurance provider stated, “Save the ER for emergencies — or cover the cost.” This message underscores the intent to alleviate emergency room congestion by ensuring that only those in genuine need seek care in these facilities.
Defining an Emergency
Anthem defines an emergency as a medical or behavioral health issue of recent onset and sufficient severity that a reasonable person would believe immediate care is necessary. This includes conditions such as severe pain, chest pain, stroke, unconsciousness, and other acute symptoms that could jeopardize a patient’s health or bodily functions.
While Anthem aims to reduce misuse of emergency services, the decision on what constitutes a true emergency rests with the insurance company. This means that if Anthem determines a visit was unnecessary, members could face significant out-of-pocket expenses.
Exemptions from the Policy
An Anthem spokesperson clarified that children under 14, visits on holidays or Sundays, and those residing more than 15 miles from an urgent care center are exempt from this policy. The spokesperson emphasized that symptoms like chest pain, which might indicate a more serious condition, warrant emergency evaluation, even if they turn out to be benign.
Criticism from Medical Professionals
The policy has drawn criticism from the American College of Emergency Physicians (ACEP), which argues that it could violate the prudent layperson standard—enshrined in federal law and applicable in over 30 states. ACEP’s president, Dr. Sarah Johnson, remarked, “Patients should not be expected to self-diagnose. If someone believes they are experiencing a medical emergency, they should seek immediate care.”
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Conclusion
In summary, Anthem’s new ER charge policy raises significant concerns regarding access to emergency care, particularly for individuals with chronic conditions. As the healthcare landscape continues to evolve, it is crucial for patients to remain informed about their rights and the implications of such policies. For further information on related topics, visit Modern Family Blog, a trusted resource in the realm of family health and wellness.