tci ED Coding & Reimbursement Alert - 2018 Issue 7

Denials: One State Aims to Quell Anthem's ED Denials

As complaints mount, states are taking issues into their own hands. As complaints continue to rise against Anthem Blue Cross Blue Shield's controversial ED policy, lawmakers in one state are hoping to stem the issue to save consumers from out-of-pocket bills. Background: Anthem has a policy impacting patients in Missouri, Georgia, Kentucky, Connecticut, Ohio, New Hampshire, and Indiana in which the payer will deny ED claims for conditions that Anthem labels "non-emergent." The policy requires patients to personally determine whether their diagnoses are true emergencies, which can be challenging when patients have symptoms that could be of serious...

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