Physicians Question Anthem ER Policy

Dec 8, 2017

Indiana emergency physicians are concerned a new insurance policy to curb emergency department visits could scare away patients. The Anthem policy, already in place in three other states, will take effect in Indiana next month.

The policy reviews diagnoses after emergency room visits. If it determines the condition wasn’t an emergency, it may not cover the ER trip.

American College of Emergency Physicians Indiana chapter president Gina Huhnke says patients can’t expect to know which symptoms are life-threatening.

“For example, patients come with abdominal pain and they may have an ovarian torsion which requires surgery or they may just have gastroenteritis which they can manage at home,” Huhnke says.

Hunkey says physicians believe the policy violates a federal law standard that requires coverage based on symptoms, not final diagnosis.

“Currently under federal law prudent layperson states that anyone who has symptoms suggestive of an emergency should be allowed to access care,” says Huhnke.

In a statement, Anthem says it will cover claims that meet that so-called layperson standard. The Indianapolis-based insurance company says its policy will also cover ER visits if there isn’t another provider nearby or available.