Lawmakers and paramedics consider new Anthem E.R. rules

Now, after almost two months the change in policy is getting attention from Ohio lawmakers

Hospital, Ambulance Generic

YOUNGSTOWN, Ohio (WKBN) – Anthem Health Insurance company started a new program last month. They will no longer pay for emergency room visits if the patient’s condition is deemed a non-emergency.

Now, after almost two months the change in policy is getting attention from Ohio lawmakers.

Anthem Blue Cross/Blue Shield made the change to their E.R. policy on January 1. If a patient is taken to the E.R. and it is determined that their condition is a non-emergency, it will not be covered by the insurer.

“We have to transport everyone that calls 911 to the hospital, the medical facilities at that time will then justify if it gets covered by insurance or if it doesn’t get covered by insurance,” said Dave Kase, paramedic.

State representative Mike O’Brien, (D-64th District), says no announcement was made regarding the change in policy, which could affect anyone who decides to take a trip to the ER.

WKBN 27 First News reached out to Anthem and they issued the following statement:

Anthem’s ER program aims to reduce the trend in recent years of inappropriate use of ERs for non-emergencies… If a consumer chooses to receive care for non-emergency ailments at the ER when a more appropriate setting is available, an Anthem medical director will review the claim information and medical records submitted by the provider using the prudent layperson standard.”  – Jeff Blunt Anthem Public Relations

It’s not just lawmakers worried about the outcomes of this change. Some think the change may encourage people self-diagnose rather than seek emergency care.

“I hope it doesn’t deter people from using the 911 system because we are there for their emergency. Everyone determines their emergency at that time,” Kase said.

The legislation brought by some Ohio lawmakers would stop counties and cities from allowing Anthem to be their healthcare provider.  It is still being drafted but could include provisions that would deny Anthem or any health insurer who refused to pay for services at the ER, access to tax credits and government contracts with the State, Counties, and Cities of Ohio.

It will take at least a few months to see the legislation against the E.R. policy change move forward. For now, any trip to the ER Anthem-insured patients takes could be billed back to them. Often times this costs upwards of 1,000 dollars.


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