Patients are not happy with Anthem’s new emergency room coverage policy, according to a new poll, although the health insurer says it is largely misunderstood.The American College of Emergency Physicians polled more than 2,200 adults; two-thirds said they oppose insurance policies that don’t pay for emergency coverage.
Anthem has cut back ER coverage in several of its state subsidiaries, including Indiana and Missouri. It will deny claims for minor injuries and illnesses that may bring patients to the emergency department, like cuts and bruises, swimmer’s ear or athlete’s foot.
Paul Kivela, M.D., managing partner of the Napa Valley Emergency Medical Group and president-elect of ACEP, told FierceHealthcare in an interview that the “intimidation factor from insurance companies is inappropriate.”
“We see patients without regard for their ability to pay, and that’s what’s made emergency medicine in this country first-rate,” he said.Other providers worry that the policy could prevent people from seeking care in true emergencies. The poll results bear that out: 40% of respondents said they had avoided a trip to the ER in the past two years because of cost concerns. Of those, nearly half said their conditions became worse as a result.
Twenty percent said that their insurer had refused to cover a visit to the doctor, hospital or other medical service in the past two years.
But Anthem says the policy is aimed at cutting back only on unnecessary visits to the emergency room, and that patients who need emergency care can and should still seek treatment.
“It is important to understand that this program is focused on non-emergency care provided in an emergency room,” Anthem spokesperson Joyzelle Davis said in a statement emailed to FierceHealthcare.
“There’s a misunderstanding that this is a denial program for all emergency department care.”
Provider groups, including ACEP, have questioned whether Anthem’s policy violates the so-called “prudent layperson” standard, but Davis said that each non-emergency ER visit claim will be reviewed by an Anthem medical director, who will consider if the symptoms would make a patient feel that he or she was in an emergency situation.
The vast majority of the respondents (79%) backed the prudent layperson standard once it was clearly explained to them, according to the poll. Sixty percent said that insurers interfere in the relationship between patients and doctors.
“When you really need insurance is in an emergency,” Kivela said.