Anthem Says ‘Show Me’ Where It Says We Have to Pay for Your ED Visit, Missouri

Missourians who still haven’t gotten the message that the emergency room is the wrong place to be for a sore throat or other nonemergent complaints are in for a rude awakening if they’re covered by Anthem. Starting this summer, Anthem will stop paying a dime for visits to Missouri EDs if the patient is deemed to have a “minor ailment” (which, in addition to sore throat, includes, rash, mild fever, and ear or eye pain—anything that can be treated safely in a “less acute” setting). There are a few exceptions to the rule: ED visits on Sundays or major holidays; children under age 14; patients who show up in an ED where there are no urgent care centers within 15 miles; and those who have been directed to go to the ED by another physician. Despite Anthem’s explanations, Missouri hospitals are concerned that patients will be put at risk because of the new policy. Some industry experts have said a judicious middle ground might be for Anthem to step up efforts to educate patients about when they truly need to go to the emergency room, and when a visit to the urgent care centers would be more appropriate.