Insurer may not cover your emergency room visit

PADUCAH, KY – You may think twice before going to the emergency room. Anthem Blue Cross Blue Shield changed its emergency room policy over the past few years, but people are starting to see the effects on their bill now.

Many of our Facebook followers commented saying they didn’t know about this policy before Monday. Anthem’s emergency room policy states that the company will only cover emergency room visits that are emergencies. Each claim will have to meet a “prudent layperson standard” for what an emergency is.

That standard means if your symptoms showed signs of an emergency then it should be covered, but Forbes reports Anthem might instead base coverage on your diagnosis. The American College of Emergency Physicians says the policy violates the law.

Anthem said in a statement: “Anthem’s goal is to ensure the broadest access to high quality, affordable health care, and one of the ways to help achieve that goal is to encourage our members to receive care in the most appropriate setting.”

Anthem said it has seen an increase in ER visits for non-emergency treatments, and the insurer is trying to put a stop to that.

Lourdes’ list of when to go to the Urgent Care or ER

Many people are going into urgent care with the flu. According to physicians assistant Jessica Frizzell, you don’t need to go to the ER for that. “You could go to the ER, but you could also wait until the next morning to go to an urgent care that is open.”

If the doctors say it’s not an emergency, you may want to listen. Before you head on in to the emergency room, ask yourself: Is this life threatening? If it is, head on in. If not, you could face a big bill when you leave.

If the doctor sees you and says your condition is not an emergency, Anthem might not cover it. The company said they want people to chose the “best care setting” for their given medical issue.

“Severe shortness of breath, sudden severe chest pain, sudden severe abdominal pain would be reasons to go to the emergency room,” said Frizzell. “If you think you have a broken bone, you might want to consider going to the emergency room as well.”

Not only are they only for emergencies, but ER visits can be 10 times more expensive than a clinic. “We don’t send them to the ER unless it is necessary,” said Frizzell.

Anthem states that it offers a 24/7 hotline that can tell you where you should get care. Anthem said it will only cover a non-emergency ER visit if a medical provider sends you there, if the patient is under 14 years old, if there isn’t another option within 15 miles, or if it is between 8 p.m. on Saturday and 8 a.m. Monday, or on a holiday.

You can find out more information about this story and others by following Leah Shields on Facebook and Twitter.

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