tci Medicare Compliance & Reimbursement - 2018 Issue 3

Reimbursement: Anthem's Controversial ED Policy Impacts 3 More States

Outrage about the policy suggests changes won't be made without a fight. Private insurer Anthem Blue Cross Blue Shield plans to expand its contentious policy of denying emergency department (ED) claims for conditions that Anthem labels "non-emergent." The policy, which was initially launched in Missouri, Georgia, and Kentucky, has alsorolled out to patients in Ohio, New Hampshire, andIndiana. Context: 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...

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