The American Heart Association and some Missouri lawmakers hope to prevent one of the state’s largest insurance providers from denying emergency room claims on conditions that the providers consider minor ailments.
Anthem Blue Cross Blue Shield of Missouri announced last year it would evaluate emergency room visits after the fact and would no longer pay for some visits if patients turned out to have what it considered mild ailments.
The policy could be life-threatening if someone who experiences chest pain or shortness of breath decides not to go to the emergency room because of concern about paying for the visit, according to an advocacy email the AHA sent out to members and supporters. The AHA called upon Missourians to reach out to their lawmakers and support Senate Bill 982 and House Bill 2225 (they are identical) to prevent insurance companies from making determinations based on final diagnoses.
SB 982 “specifies that whether an ailment is considered an ’emergency medical condition’ depends on the person having sufficiently severe symptoms, regardless of what final diagnosis is given,” according to a bill summary.
The House bill already has been heard at committee. The Senate bill is expected to be heard during the Senate Insurance and Banking Committee hearing at 8 a.m. Tuesday.
The insurance company sent out a statement regarding its emergency room policy, said Scott Golden, spokesman for Anthem Blue Cross Blue Shield of Missouri.
“Anthem strives to make health care simpler, more affordable and more accessible, and one of the ways to achieve that goal is to encourage consumers to receive care in the most appropriate setting,” the statement says. “Anthem’s avoidable ER program aims to reduce the trend in recent years of inappropriate use of ERs for non-emergencies.”
The statement says the company realizes there could be improvements to its new policy. As of Jan. 1, it implemented a series of “always pay” exceptions to the program.
Among other things, the exceptions include paying when the patient is under 15, the visit happens between 8 p.m. Saturday and 8 a.m. Monday (or on one of 10 major holidays), a consumer was directed to the emergency room by a provider (including an ambulance provider), the consumer is traveling out of state, the consumer received surgery, or the consumer received IV fluids.
The statement said Anthem will continue to consider changes to the program.
The AHA email says a person who experiences chest pain and shortness of breath and goes to the hospital could find out they only had heartburn and be stuck with the bill.
Even with changes, the AHA believes there is the danger patients will misdiagnose themselves and choose not to go to the emergency room.
“We think this is dangerous and wrong, and it will discourage Missourians from seeking emergency care when minutes could mean the difference between life and death and avoiding lifelong disabilities,” the AHA email states. “You should not be expected to self-diagnose your condition out of concern that you can’t afford to seek care.”
The organization encourages people to reach out to their lawmakers about the effects Anthem’s policy could have on Missourians.
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