It's midnight and your young child is screaming in pain. You have sought desperately to understand what is going on and have taken every measure you can think of to alleviate the symptoms. After being wholly unsuccessful in efforts to help your loved one, you rush to the local emergency room for help.
That judgment just might save your child's life. Additionally, it could rip holes in your budget and perhaps even bankrupt you -- in the event your health insurance card identifies you as an Anthem policyholder.
That huge company (the parent of Blue Cross Blue Shield affiliates across the country) is taking a hard-line stance on ER visits by claimants, seeking to implement a uniform national standard that will flatly deny paying a dime for select visits to emergency providers. Anthem contends that much treatment rendered in ER rooms could be delivered just as well -- and more cheaply -- in urgent care clinics.
Who will make the call on that?
Unsurprisingly, Anthem states that it will do so internally, in the wake of a policyholder's determination that he, she or a loved one is in dire need of immediate medical assistance. The insurer says it will apply a "prudent layperson" standard in its evaluations.
That stance, notes one recent media spotlight on the matter, "has garnered widespread wrath" among patient advocates and care providers. Critics across a wide universe are condemning the move, calling it calloused and even disingenuous. They say it will jeopardize patient care and have a chilling effect on would-be ER goers. Moreover, and if it gains tractions, other insurers are likely to follow with similar policies.
Anthem has already been sued once on the matter. Future legal challenges seem certain to follow.