Journal of Urgent Care Medicine

Anthem Faces Charges Its Already-Unpopular ED Policy is Harder on Low-Income Patients

Physicians and patients alike have been vocal in their disapproval of Anthem’s policy of denying claims for emergency room visits that are ultimately declared nonemergent—the main criticisms being that it forces patients to self-diagnosis to some extent and that it ultimately may discourage patients from getting emergency care when they really do need it. Now the Indianapolis Recorder newspaper charges the policy is going to have the greatest negative impact on low-income patients, based on …

More Data Quantify ED Visits That Could Be Avoided

Nonbiased parties outside of the urgent care arena are picking up on the idea that many people who visit the emergency room don’t really need to be there—and there are more data demonstrating that all the time. Most recently, the International Journal for Quality in Health Care published research stating that 3.3% of ED visits are “avoidable” altogether. The data reflect more than 424 million ED visits by patients between 18 and 64 years of …

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 …

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 …

Anthem, Cigna Set to Square Off Against the Justice Department

Urgent care operators are watching with interest as Anthem and Cigna Corp. prepare to fight for their proposed $53 billion merger. The U.S. Justice Department has already expressed concerns about the deal moving forward, claiming that federal and state regulators complain consummation would reduce competition, leading to higher prices and lower levels of service. For their part, Anthem insists the proposed massive new company would be in a better bargaining position to negotiate deals with …