Anthem Health Charges Patient $12,596 for Emergency Room Visit

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Here’s a new health care insurance outrage:

The news website reports that, after announcing a new policy that will reject “inappropriate” emergency room visits, Anthem Health rejected a claim from a woman in Kentucky who went to the emergency room thinking she had appendicitis.  It turned out she had ovarian cysts. Anthem is trying to cut ER visits and initially refused to pay after reviewing her emergency room visit.  The company rolled out the change in policy and sent letters to its subscribers in four states – Missouri, Kentucky, Indiana and Georgia. –

There is usually no way for a patient to know  what the cause is when they have sudden severe pain.  The Anthem decisions on emergency room visits are made after the fact when they can look at the entire record and see what the patient was eventually treated for.   There is a fairly frequent possibility of patients having these denials of coverage happen.   For example, people thinking they are having a heart attack  offer are only experiencing  severe heartburn.  Should they not be cautious and go to the emergency room anymore?

This issue is just another example of insurance companies putting more importance on cutting costs than providing coverage that they have been paid for.   It seems that the company should have a referral hotline  or another way for a patient to know until after the fact whether the visit will be paid for.  It seems that public education and urging people to go to urgent care or other clinics needs to be the appropriate method to reduce emergency room visits.

The Anthem decision brought an outcry and an initial appeal from the patient that was denied.  Suddenly after the media got a hold of the case, Anthem changed its tune and reversed itself, apologizing for an problems the patient had.

Here’s the link to the full story


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I have been a senior advocate for most of my career. I was Executive Director of the New York StateWide Senior Action Council and the New York State Alliance for Retired Americans. In 2007-2010 I was the Director of the New York State Office for the Aging

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