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Anthem Cracking Down on ER Visits

Tuesday, January 2, 2018   (0 Comments)
Posted by: UCAOA/
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 Anthem wants to prevent trips to the emergency room for people who are seeking medical help for constipation or an ingrown nail.

Starting in 2018, the state's largest health insurer plans to stop covering certain services it deems are not medically necessary if people seek treatment at the emergency room.

The cost-control measure lists more than a dozen services, including pregnancy tests, high-blood pressure checks as well as mild contusions and sprains. The costs would be covered for children under 14.

The American College of Emergency Physicians and its New Hampshire chapter this month announced its opposition to Anthem's move.



"Health insurance companies can't expect patients to know which symptoms are life-threatening and which ones are not, and they shouldn't be punished financially because of it," said Dr. Thomas Joseph Lydon, vice president of ACEP's New Hampshire chapter.

"This violates the prudent layperson standard, which is part of Medicare and Medicaid laws, as well as the Affordable Care Act and requires coverage to be based on a patient's symptoms rather than a diagnosis," Lydon said.

Anthem spokesman Colin Manning said Friday that emergency rooms are "an expensive and time-consuming place to receive care."

"Anthem's overall goal is to ensure the broadest access to high quality, affordable health care, and one of the ways to help achieve that goal is to encourage our members to receive care in the most appropriate setting," Manning said. 


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