Anthem to stop covering ER visits in Indiana

INDIANAPOLIS — Indiana-based health insurance provider Anthem will be telling customers during the next enrollment period that it will not cover emergency room visits it considers non-emergency.

The company told TV station Fox59 that it had already established the policy in three other states.

From Fox59:

Anthem said it anticipates of the 190,000 annual visits to Indiana emergency rooms for its customers, it will begin denying roughly four percent of claims, or about 7,600 a year.

“If a member chooses to receive care for non-emergency ailments at the ER when a more appropriate setting is available, their claim will be reviewed using the prudent layperson standard and potentially denied,” the company said in a statement to FOX59.

Furthermore, Anthem said, each claim will be reviewed by an Anthem medical director taking into consideration the patient’s symptoms and eventual diagnosis and patients can appeal any denial.

Exceptions to the new rule will be made – including for anyone under the age of 14, situations where there isn’t an urgent care or retail clinic within 15 miles of the patient or on Sundays.

The Indianapolis Star reported that both doctors and patient advocates worried the policy would force people to make financial decisions in situations when time could be important.

From the Star:

“Patients will be too often forced to be their own doctors,” said Scott Mulhauser, board member of the advocacy group Consumers for Quality Care. “Consumers shouldn’t be evaluating their care in these tense moments …. You don’t want to guess wrong because the consequence can change your life forever.”

With the new policy, patients may delay getting care they need, afraid of incurring a hefty bill, said Dr. Chris Burke, a board member of the Indiana American College of Emergency Physicians.

Fox59 said a specific date for the policy to start had not been set.