Follow-up: AMA Cries Foul over New Anthem ED Policy

We’ve told you recently about plans some insurers have to stick patients with the bill for emergency room visits that are retrospectively determined to have been nonemergent in nature. In essence, if patients go to the ED with an illness or injury that could have been handled in a lower-acuity setting (such as an urgent care center), as determined by the insurer, the patient’s claim will be denied. Now the American Medical Association is demanding that Anthem Blue Cross Blue Shield, for one, rescind that policy immediately in states where it’s taken effect and to squelch plans to implement it in other states. In a letter to Anthem, AMA Executive Vice President and CEO James L. Madara, MD charges that Anthem’s new policy both diminishes the value of health insurance that has already been bought through Anthem and forces patients to make self-diagnoses they’re not qualified to make, especially when suffering whatever symptoms they’re seeking help with. The American College of Emergency Physicians and the Medical Association of Georgia have also joined the AMA in suggesting that the policy could violate the “prudent layperson standard.” For its part, Anthem says roughly 1% of ED claims have been denied thus far. (That figure does not reflect patients who self-selected out of the ED, but could have gone there for legitimately emergent concerns, of course.)