Missouri Sen. Claire McCaskill, D, requested information regarding Anthem's decision to no longer cover emergency department care it deems nonemergent, the St. Louis Post-Dispatch reports.
As of June 1, Anthem began reviewing diagnoses after members' emergency room visits in Missouri. Under the rule, if a patient's condition is determined to be nonemergent, Anthem may not cover the ED visit. Exceptions include ED visits for policyholders under age 14, patients with physician referrals to the ED, patients who lack of urgent care accessibility, and visits made on a holiday or Sunday when nonemergent facilities may be closed.
In a Dec. 20 letter, Sen. McCaskill asked Anthem to turn over several documents concerning the new policy, including internal communications on potential cost savings, customer complaints about the rule and related hospital communications.
"Patients are not physicians. I am concerned that Anthem is requiring its patients to act as medical professionals when they are experiencing urgent medical events," Sen. McCaskill wrote.
Sen. McCaskill requested the information be provided no later than Jan. 19, 2018.
Anthem's policy is in effect in Missouri, Kentucky and Georgia, and will expand to Indiana next year.