Patients throughout New York are at risk of surprise bills for emergency department visits later deemed a “non-emergency” by their insurer. As reported in the recent Associated Press story you published, “Is it an emergency? Insurer makes patients question ER visit,” Anthem recently changed its emergency department policy for New York policyholders, 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 only 3.3 percent of emergency department visits can be considered “avoidable.” The research shows that defining what constitutes an “avoidable” visit is arbitrary, and determining this after the fact overlooks the disparity between initial symptoms and final diagnosis. Understandably, it is difficult for anyone other than a licensed medical practitioner to diagnose symptoms as an emergency.
With the implementation of its emergency department policy, Anthem has taken action to increase fear and worry, as well as confusion, around emergency department visits.
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 here: http://www.dfs.ny.gov/consumer/fileacomplaint.htm. Consumers may also call the toll-free hotline at (800) 342-3736.
As long-time health care advocates, we want to highlight these resources, along with the UCSF study and 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.
Dr. Donna Christensen
Christensen is a board of directors member of Consumers for Quality Care and a former member of the U.S. Congress