A group of doctors filed suit against health insurance company Anthem for its pay practices over emergency room (ER) care.
The doctor group, the American College of Emergency Physicians, as well as the Medical Association of Georgia, alleged that insured patients would be responsible for their own ER costs unless deemed an emergency in their complaint. ACEP is a Texas-based industry association of physician members.
Anthem, the nation’s largest for-profit managed health company in the Blue Cross and Blue Shield Association, started the pay practice in June 2017 in Missouri and Kentucky, and in July 2017 in Georgia, according to the lawsuit. The policy was also expanded to Indiana, New Hampshire and Ohio.
The policy led Anthem to retroactively deny payment to healthcare providers for services already after the company reclassified encounters with the ER as “non-emergent.” Anthem maintained the policy aimed at cutting back use of the ER when patients didn’t require it.
“As a result, providers and patients alike are operating in fear of denial of payment by Defendants when patients seek emergency department care,” the doctors said in the filing.
Anthem’s practices went beyond what is lawfully allowed, the complaint alleged, and harmed the physician groups and members.
Anthem has also declined to pay for imaging in hospitals when it could have been done at a lower-cost facility.
The policy has come under fire earlier this year, and Anthem even softened the policy somewhat. ACEP denounced those changes as not going far enough in February.
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."