Anthem Insurance pushing people away from ER visits

If you have Anthem Blue Cross Blue Shield insurance, you might want to think twice about going to the emergency room.

Posted: Jan 3, 2018 10:05 PM

WEST LAFAYETTE, Ind. (WLFI) — If you have Anthem Blue Cross Blue Shield insurance, you might want to think twice about going to the emergency room.

According to Anthem it's restricting the number of reasons they will cover your bill at the ER.


This is something that insurance companies have been trying to do for years: discourage people from visiting the ER, when they can get the same, less expensive treatment done, at an urgent care.

But Allison Loy, any many others, say this isn't the right way to go about it.

"I think it's ridiculous," said Loy.

That seems to be the common theme with this new rule from the nation's second-largest insurance company.

This new rule puts a lot of pressure on you to make the right medical decision for yourself, or your child if they are younger than 14.

"It's very difficult for me to decide if my kids need emergency care," said Loy.

According to Anthems website, these are the symptoms that qualify for an ER visit:

Heavy bleeding
Large wounds
Broken bones
Severe Burns

Those are more of the obvious reasons.

But they also mention:
Head injuries
Difficulty breathing
Chest pains.

But if the diagnosis ends up not being severe, it could lead to a hefty bill.

This happened to Loy's friend.

"He called the nurse on the back of the card, he followed procedure, he was really sick, they told him to go to the ER. And they are refusing to pay the bill," explained Loy.

CEO of Franciscan Health Terry Wilson says he disagrees with how Anthem is handling this.

"At the start, it's the patient who gets left holding the bag so to speak," said Wilson. "Not Anthem, not the hospitals, not the doctors, because we are compelled, if we worked someone up in the ER to send them a bill."

Wilson also said he, along with other hospitals, in the area reached out to Anthem to try and stop this. But their efforts were unsuccessful.

News 18 reached out to Anthem but have yet to hear back.

There are exceptions to this new rule.

You will not get charged if there isn't an urgent care center 15 miles from your house, if you need help on a Sunday or major holiday, if you get a recommendation from a doctor to go to the ER or if someone is under the age 14.

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