Deciding whether the pain you feel is an emergency or not should be left to licensed medical professionals. However, as reported in your recently published story, “Is it an emergency? Insurer makes patients question ER visit,” patients in Washington 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 here: insurance.wa.gov/complaints-appeals. Consumers also may call the toll-free hotline at 800-562-6900.
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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(Christensen is with Consumers for Quality Care Board)