A group of emergency room doctors is pushing back on a program from Anthem Blue Cross and Blue Shield that could deny reimbursement for those using the hospital emergency room for treatment the insurer doesn’t deem an emergency.
Emergency room physicians say the policy ultimately could lead to higher health-care costs or even lost lives.
But the Indianapolis-based insurance company said treatment in a hospital emergency room is considerably more expensive and time-consuming than if a patient had gone to an urgent care or walk-in clinic.
In an attempt to contain healthcare costs, it began testing a program — that began rolling out in Georgia, Missouri and Kentucky in 2015 and was extended Jan. 1 to include Indiana, Ohio and New Hampshire — that could deny reimbursement for emergency room visits the insurer deems unnecessary.
The program applies to those with an Anthem plan provided from an Indiana employer or a policy that was purchased on the individual market. Anthem would not reveal how many customers it has, but the company indicated it is the largest health plan in the state.
“Anthem’s avoidable ER program aims to reduce the trend in recent years of inappropriate use of ERs for non-emergencies as the costs of treating non-emergency ailments in the ER has an impact on the cost of healthcare for consumers, employers and the health care system as a whole,” Anthem spokesman Tony Felts said via email.
But the change has caused a backlash of criticism and stories of people who went to the emergency room because they thought they were suffering from a serious issues, but ended up with significant medical bills because their conditions were deemed to be non-emergency matters.
The American College of Emergency Physicians has fought back against the policy by issuing press releases and videos highlighting the dangers in the program. Beacon Health System declined to comment on the issue, but Saint Joseph Health System indicated it has taken action to build awareness about the change with signage and handouts throughout its physician network locations.