Anthem’s ER policy called ‘dangerous,' ‘unfair to patients’
In an effort to steer patients toward less expensive sites of care, Anthem has instituted policies in several states that if an emergency room (ER) visit is determined to be unnecessary, they may end up footing the bill—something 34-year-old Allison Wrenne learned the hard way.
When abdominal pain forced her to the floor one morning, her neighbor—a physician assistant—told her to go to the ER. She was diagnosed with a ruptured ovarian cyst. In Anthem’s opinion, that wasn’t an emergency, so Wrenne was sent a bill for $4,110.
“How are you supposed to know that?” she told the Associated Press. “I’m not a doctor ... that’s what the emergency room is for.”
While physicians agree ER isn’t the right option for many minor injuries, they’re concerned this Anthem policy will scare patients away from going there for real emergencies out of fear of receiving a hefty bill. Jesse Pines, MD, an emergency medicine professor at George Washington University, called it the policy “totally unfair to patients.”
A recent study found only 3.3 percent of ER visits between 2005 and 2011 could be classified as avoidable, calling into question limiting ER access as a strategy to prevent overutilization.
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John joined TriMed in 2016, focusing on healthcare policy and regulation. After graduating from Columbia College Chicago, he worked at FM News Chicago and Rivet News Radio, and worked on the state government and politics beat for the Illinois Radio Network. Outside of work, you may find him adding to his never-ending graphic novel collection.