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Health insurers are disagreeing with your decision to visit the emergency department — and refusing to pay.

Anthem Blue Cross Blue Shield has announced it will not pay for emergency visits in Georgia,  Kentucky and Missouri, based on a secret list of diagnoses (nearly 2,000 in Missouri from a list that ACEP was able to obtain).  Other insurance companies could follow.  Anthem has been warning patients it will deny coverage after the fact if they determine it was not a medical emergency even if the patient thought it was an emergency. 

 

 
ER Stories
“Health insurance companies are scaring people away from emergency departments, saying they will decide after the fact what is a real emergency. If your insurer disagrees with your decision to visit the ER, they may now refuse to pay. These new actions violate federal law and are dangerous, because people with identical symptoms — such as abdominal or chest pains — may either have a deadly medical condition or a non-urgent issue. It is not fair for health insurers to expect patients to know the difference between a heart attack and something that is not life threatening.”
– Rebecca Parker, MD, FACEP, president of ACEP
If you’ve been denied coverage for an emergency visit, we want to hear your story!
 

kivela“Patients shouldn’t diagnose themselves out of fear their insurance company won’t cover a visit to the emergency department,” said Paul Kivela, MD, FACEP, ACEP’s incoming president.  “Burning chest pain, for example, may be heartburn, but it also can signal a heart attack.  How can we possibly expect a non-medical person to know the difference?”

 

Morning Consult Infographic Prudent Layperson

“Insurance companies must be transparent about how they calculate payments and provide fair coverage for their beneficiaries and pay reasonable charges, rather than setting arbitrary rates that don’t even cover the costs of care. Seventy-nine percent of the emergency physicians who were familiar with the Fair Health database said it is the best mechanism available to ensure transparency and to make sure insurance companies don’t miscalculate payments.”
– Rebecca Parker, MD, FACEP, president of ACEP

 
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