Deciding whether the pain you feel is an emergency or not should be left to licensed medical professionals. However, as reported in the recently published story, “Is it an emergency? Insurer makes patients question ER visit,” patients in Pennsylvania are being forced to make that determination themselves to avoid being stuck paying thousands of dollars in medical bills. This is a result of Anthem, America’s second largest insurer, changing its emergency department policy, citing the need to unburden overcrowded emergency rooms and decrease the high costs of emergency care.
This policy change goes against findings of a recent University of California at San Francisco study, in which researchers found that that defining what constitutes an “avoidable” visit is arbitrary, and determining this after the fact overlooks the disparity between initial symptoms and final diagnosis.
We encourage consumers having issues with emergency treatment, or those with questions or concerns about this policy, to file a complaint with their state insurance commissioner at http://www.insurance.pa.gov/Consumers/File%20a%20Complaint/Pages/default.aspx. Consumers may also call the toll-free hotline at 877-881-6388.
As long-time health care advocates, we urge Anthem to fix its policy. We believe it violates the basic tenets of the insurer/patient agreement and provides yet another example of abusive practices that prevent Americans from accessing quality health care.
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Donna Christensen, M.D., Washington, D.C.
The writer is a former member of Congress and on the board of Consumers for Quality Care.