Some Anthem patients afraid to use ED under new policy: 6 things to know

Ohio residents with Anthem insurance told The Plain Dealer they fear Anthem's discretionary emergency department policy will negatively affect them.

Here are six things to know from the article.

1. Anthem rolled out its controversial ED policy in Ohio Jan. 1. Under the coverage change, the insurer reviews diagnoses after members' ED visits. If their condition is determined to be nonemergent, Anthem may not cover their ED claims, with several exceptions.

2. The Plain Dealer asked readers Feb. 22 to submit their experiences under the new policy. "Readers say they are afraid to visit the emergency room and potentially be saddled with expensive medical bills," the newspaper found.

3. One reader who is covered through his wife's Anthem policy, Matt Vale, told The Plain Dealer, "I wonder every day if me or my wife have a trip to the ER, will it be covered?"

4. Ohio Department of Insurance Assistant Director of Public Affairs Chris Brock told the publication the agency will continue to monitor the policy change. Mr. Brock also strongly encouraged Anthem members to review and file a complaint with the department if they have a concern about their claim.

5. Anthem has said its ED policy aims to cut the costly and improper use of EDs for nonemergent reasons. The policy is in effect across Ohio, Indiana, New Hampshire, Missouri, Georgia and Kentucky.

6. The Ohio American College of Emergency Physicians, Ohio Hospital Association and Ohio State Medical Association are collecting ED claims Anthem denies to submit to the Department of Insurance, according to the report.

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