Is it an Emergency? Insurer Asks Patients to Question ED Visits

INDIANAPOLIS (AP) — Alison Wrenne was making waffles for her two young children one morning when abdominal pain forced her to the floor. A neighbor who is a physician assistant urged her to go to the emergency room. Wrong decision, according to her health insurer. Wrenne was diagnosed with a ruptured ovarian cyst, but Anthem said that wasn't an emergency and stuck her with a $4,110 bill. "How are you supposed to know that?" said the 34-year-old from Lexington, Kentucky. "I'm not a doctor ... that's what the emergency room is for." In an effort to curb unnecessary and costly ER visits, the Blue Cross-Blue Shield insurer has told customers in a few U.S. states to go to the hospital only in a real emergency such as a heart attack, stroke and major bleeding — or they could wind up footing the bill. Anthem, the nation's second-largest insurer, wants patients to consider alternatives like drugstore clinics, nurse advice hotlines or telemedicine. Insurers for years have been raising ER co-payments to try to deter unnecessary — and expensive — visits, and Anthem's policy marks another round in this long-standing fight. Even doctors agree the ER — an important revenue source for hospitals — isn't the best option for minor complaints like sinus infections, rashes or ankle sprains. They say it's better in those cases to see a family doctor who knows a person's medical history. But some also worry that Anthem's clampdown will scare patients away from the E...
Source: JEMS: Journal of Emergency Medical Services News - Category: Emergency Medicine Authors: Tags: Patient Care News Administration and Leadership Source Type: news