Solving the problem of non-emergent care in the emergency department

I recently opined about a decision by Anthem to deny paying for emergency room (ER) care that it deemed to be non-emergent.  My point was that insurance companies should not be obligated to pay for routine, non-emergent care, recognizing that we need a fair and reasonable method to define a medical emergency.   In my view, payment should not be denied to a patient who reasonably believes he needs ER care, even if the symptoms are (hopefully) found to be innocent after a medical evaluation. For example, if a patient develops chest pain at 10 p.m., and is worried about an acute cardiac issue, he should call 911.  If the ER determines that chest pain is simple heartburn, it would not be reasonable for Anthem to deny payment for this ‘non-emergent’ condition.   We’re all a little smarter after the fact once we know the outcome. Some medical complaints, however, are never medical emergencies.  If you want ER care for a runny nose, a cough or a sore knee, and you proceed to the ER, explain why you think your insurance company should pay for this. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Policy Emergency Medicine Source Type: blogs