Patients concerned about anthem policy that would leave them with the bill for er visits local news joplinglobe.com chamomile tea for heartburn

Anthem, the nation’s second-largest insurer, recently became the first company in Missouri to review emergency room charges after the fact. If the company determines that the visit was necessary — as in, say, an actual heart attack — it will pay its share of the bills. But if the visit doesn’t amount to more than heartburn, Anthem could deny coverage and those bills, which could amount to thousands of dollars even for a false alarm, could be the responsibility of the patient.

“Time is of the essence when it comes to a heart attack,” Jana said. “If people are afraid that they’ll have to pay hundreds or even thousands of dollars to go to the ER, they’re not going to go unless they really think they’re having an emergency.”

Last year, customers in Missouri and Georgia started getting letters from Anthem warning them that minor complaints should be checked out at places like clinics or urgent care centers, where visits can cost $85 and $190, respectively.


By comparison, Anthem says a typical ER visit can run into the four figures.

The ER should be used as it was designed — to treat life-threatening illness, Dr. Craig Samitt, Anthem’s chief clinical officer, said last year when the policy became public. This is in no way meant to compromise a member’s determination of whether they’ve got an emergency.

Samitt said at the time that Anthem wasn’t simply rejecting every non-urgent ER claim it received. The insurer has a physician review a case before issuing a denial and would consider a patient’s circumstances. Anthem said it may cover a patient who arrives with chest pains that turn out to be indigestion instead of a heart attack. However, hospital officials in Missouri say many of Anthem’s reviews haven’t been thorough. The insurer was accused of rejecting some claims in only a couple days and in some cases hadn’t even requested patient records before making a decision, according to Daniel Landon, a senior vice president with the Missouri Hospital Association.

In a statement responding to a Globe request for an interview, Scott Golden, an Anthem spokesperson, said: “Emergency rooms are an expensive place to receive care. The costs of treating nonemergency ailments in the ER has an impact on the cost of health care for consumers, employers and the health care system as a whole.”

Anthem hoped its new policy would dissuade patients from needlessly visiting the ER, but the company faces blowback from lawmakers, hospital groups, patients and those like Smith. Last month, Anthem announced tweaks to the policy, outlining a number of scenarios in which it said it will always cover emergency care.

For instance, if the patient receives an MRI or CT scan during an emergency room visit, Anthem will pay for the visit under the revised protocol. The same goes for patients under 15 years old, patients who live more than 15 miles from an urgent care center, and patients who were directed to the ER by an ambulance crew, among other “always pay” scenarios.

Karen Englert, the group’s government relations director in Missouri, says even the revised policy puts cardiac patients at risk. She worries that other companies will follow Anthem’s precedent. UnitedHealth, the nation’s largest insurer, began a similar policy this week for some of its patients.

She added that the potential cost of an ER visit could discourage some cardiac patients from visiting the ER when they believe they may be having a heart attack. A basic visit to the ER at Mercy in Joplin ranges in cost from $450 to to $1,300, excluding tests and physician fees, according to a hospital spokeswoman.

ER costs are the focus of several bills currently under debate at the state capital. Two bills attempt to bring down the cost of ER visits by adjusting incentives for insurers and hospitals. A third bill, proposed by state Sen. Paul Wieland, R-Imperial, garnered the support of the AHA for its patient-centered approach. It defines an “emergency medical condition” based on symptoms — not a doctor’s ultimate diagnosis — effectively rendering Anthem’s policy illegal.

The bill will be debated this week by the full Missouri senate after receiving a unanimous yes vote in committee. Support for the bill goes beyond the American Heart Association. In a March 5 letter to an Anthem executive, which was obtained by the Globe, the executive director of the American Hospital Association expressed concerns about the company’s policy and not just with heart attacks, but with other medical emergencies. Thomas P. Nickels, pointed to the story of a Kentucky woman who was billed $12,000 after going to the ER with symptoms that she incorrectly attributed to appendicitis.