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Anthem Blue Cross Blue Shield, the nation’s largest health insurer, is expanding its policy of not paying for emergency room (ER) care that it decides was not an emergency.
If you are enrolled in an individual Anthem plan in New Hampshire, Indiana or Ohio, you will soon be joining members in Georgia, Missouri and Kentucky who already have had to think twice before going to the ER.
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“Save the ER for emergencies. Or you’ll be responsible for the cost,” Anthem stated in letters to subscribers affected by the policy change. “Anthem’s ER program aims to reduce the trend in recent years of inappropriate use of ERs for nonemergencies,” an Anthem spokesperson said in an email.
Historically, overuse of the emergency department has been considered a key contributor to rising health care costs. The Centers for Disease Control and Prevention reported a record 141.1 million visits to ERs in 2014, the latest year data is available. Insurers have attempted to control costs by imposing separate deductibles for emergency room care that doesn’t result in an admittance to the hospital and by charging lower copays to patients who go to an urgent care center or retail health clinic.
Anthem’s decision whether to pay an emergency room bill is based on a doctor’s diagnosis — not the reason the patient went to the hospital. So if you go to the ER with chest pains and it turns out you had indigestion, or if you fell but your ankle was sprained and not broken, under Anthem’s policy you’ll probably have to pay the entire bill.
The financial consequences for a wrong self-diagnosis can be significant. Being denied reimbursement for an emergency room visit can cost patients thousands of dollars. A 2013 study funded by the National Institutes of Health found that ER charges varied widely — from $740 for an upper-respiratory infection to $3,437 for a kidney stone.