tci ED Coding & Reimbursement Alert - 2018 Issue 3

ED Payments: Anthem Extends Policy Denying "Inappropriate" ED Visits to 3 More States

Physician groups, lawmakers fight against expanded policy. Private insurer Anthem Blue Cross Blue Shield is expanding its controversial policy of denying ED claims for conditions that Anthem labels "non-emergent." The policy, which was initially launched in Missouri, Georgia, and Kentucky, has also rolled out to patients in Ohio, New Hampshire, and Indiana. The company is essentially asking patients to make self-determinations of their diagnoses after evaluating their conditions. "If you chose to receive care for non-emergency ailments at the ER when a more appropriate setting is available, your claim will be reviewed using the prudent layperson standard and...

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