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Anthem Blue Cross Blue Shield has announced it will not pay for emergency visits in six states: Indiana, Georgia, Kentucky, Indiana, Missouri, New Hampshire and Ohio, based on secret lists of diagnoses (nearly 2,000 in Missouri from a list that ACEP obtained). Unless stopped, this policy could be implemented in more states, with additional health insurance companies following with policies of their own.
This policy is unlawful, because it violates the prudent layperson standard, which is part of federal law, including the Affordable Care Act, and 47 state laws. Patients can’t be expected to self-diagnose their medical conditions. Two people may have identical symptoms but have different diagnoses — one life threatening, one non-urgent.