Can anyone believe this shit?!

[Ohiogal]

In 3 States, if Anthem Thinks You Shouldn't Have Gone to the ER, They Won't Pay

When you decide to make a trip to the ER for symptoms such as chest pain or difficulty breathing, you do it because you are concerned that this could potentially be a life-threatening situation. After undergoing careful medical evaluation including X-rays, EKGs, ultrasounds or CT scans in the ER, the end result might indicate a condition that isn’t dangerous, such as pleurisy or bronchitis.

But this very process and the assurances to systematically arrive at a final diagnosis are being threatened by one insurance company that is creating a list of specific diagnoses they are choosing not to cover.

Anthem Blue Cross Blue Shield is placing policy holders in Kentucky, Missouri and Georgia on notice that they could be responsible for covering the cost for such ER visits. It turns out that Anthem has developed a specific list of diagnoses that it will not cover, such as “chest pain on breathing” and blood in the urine, even if the patient thought it was a medical emergency.

“Health insurance companies are scaring people away from emergency departments, saying they will decide after the fact what is a real emergency,” Rebecca Parker, MD, FACEP, president of the American College of Emergency Physicians (ACEP), said in a news release published online last Tuesday. “If your insurer disagrees with your decision to visit the ER, they may now refuse to pay. These new actions violate federal law and are dangerous because people with identical symptoms — such as abdominal or chest pains — may either have a deadly medical condition or a non-urgent issue. It is not fair for health insurers to expect patients to know the difference between a heart attack and something that is not life threatening.”

More

https://www.forbes.com/sites/robertglatter/2017/10/16/anthem-at-odds-with-your-decision-to-visit-the-er-and-refusing-to-pay-in-certain-states/#5f0fc1054356

[Vinca]

1. So I guess Anthem prefers to pay for the ambulance to travel to your house while

you're having a full blown heart attack and, if you survive, weeks in the ICU. Fucking insurance companies.

[onethatcares]

14. oh, hell no

do you have any idea how expensive those ambulance rides are?? Jeeebuss, we gotta cut out the thrill seekers that only want to hear a siren while tying up emergency personell

[Xipe Totec]

24. Don't worry. They'll be sued by life insurance companies for wrongful death

If money is involved, ...

[Eliot Rosewater]

2. ACA wouldnt allow this, how is this happening?

[Maraya1969]

9. That is my thought. There were laws enacted to stop this type of abuse by insurance cos in the ACA.

Someone is fucking with the laws

[JenniferJuniper]

3. This is actually common, my group health

policy from my employer reserves the right to refuse to pay for an ER visit if they deem it a non-emergency after-the fact. Cigna.

I think if many people checked their policies closely they would find the same sort of provision.

[gvstn]

7. This happened to me years ago

Blue Cross blue shield.

It was an anxiety situation but still frightening. They refused to pay. I still think they were in the wrong.

[uponit7771]

32. Common but not legal under ACA but the insurance companies don't have to care (link inside) to get

... them to cover legally

https://www.healthcare.gov/appeal-insurance-company-decision/external-review/

[Leith]

38. Yeah - It's Been That Way for Years

My insurance (employer) says that the patient has to have insurance approval before going to emergency.

Oooooh! But we don't want a gubmint bureaucrat coming between us and our doctors!

[CTyankee]

4. I absolutely hate going to the ER. It's crowded and noisy and there is always a triage wait.

I had to take my husband there a few times and it was just terrible. I'm glad he got the help and I know it is a good thing but the experience in the ER is just awful. If possible, I want to be treated in my own home. Once I collapsed on the kitchen floor and two male next door neighbors were called by my husband and one carried me upstairs to my bed. I was so grateful.

[MontanaMama]

5. Insurance companies have too much power.

It is THAT simple. Every one of them is a criminal enterprise.

[dalton99a]

6. Indiana Insurance Commissioner says it's ok

https://www.indystar.com/story/news/2017/08/23/think-you-need-go-er-if-your-insurer-doesnt-agree-you-could-pay/591249001/

This past week, the advocacy group sent Indiana Insurance Commissioner Stephen Robertson a letter asking that he reject the policy.

The insurance department conducted a review and decided not to act further, said Jenifer Groth, director of communication and outreach.

"IDOI completed its review and determined the program is not changing any prior coverage and does not constitute a procedural or benefit change," she wrote in an email. "The program is to make policyholders aware of the process for payment of ER claims by sending information that outlines how coverage of claims will be handled."

[Maraya1969]

10. When you call your doctor you are ALWAYS told, "If this is an emergency hang up and call 911"

Maybe you could say that you called the doctor, he wasn't in and you were INFUCKINGSTRUCTED to call 911

[JenniferJuniper]

17. Problem is, the insurance company gets to decide

what an "emergency" actually is.

They want us all to go to much cheaper urgent care. Problem is, sometimes you don't have the time for the additional stop.

[Ohiogal]

8. Okay

I'm having chest pain and I'm no damn doctor but it's 3am and this is something I've never had before and it's scaring me.

If I know my insurance may not pay for a trip to the ER, I might think, "I'll just try and wait it out and see if it's anything that bad...."

Well, what if I end up having a full blown heart attack and get help too late .... because I was afraid of going to the ER and "bothering them unnecessarily."

I hope they get hit with a whole bunch of lawsuits over this.

Also, how many times do you call your Dr.'s office and you get a recording that says "If this is an emergency please go to your nearest ER." I guess they'd better amend their little phone message .... "But, first, call your insurance company and let them put you on hold for a half an hour before you get a person on the line whom you can ask if you can please go to the ER. .... if you're still breathing."

!!!!!!!! I hate insurance companies!!!!!

[LuckyCharms]

11. This shit is common with these companies.

It is not legal according to your post from the article, but apparently they don't care. I guess there is no one putting the hammer down on them for this activity...so they continue to do it.

It's more than infuriating.

Try not to think about it until you need to, or else your blood pressure will rise. Seriously, this kind of stuff make me want to move to another country.

PS....I have "good" insurance, and I just got a bill for an ER visit and related tests. I threw it in the garbage. I ain't paying it.

[Ohiogal]

12. You aren't the only one, Lucky

who has thought about moving to another country. Health care in this country is fucked up, plain and simple.

My only hope is that once Dems regain control, we can get rid of these greedy and cruel assholes who run things now, and re-institute the ACA rules.

How many times I have heard friends say, like you, "I have "good" insurance, and I still had a huge bill for this or that...."

[kentuck]

13. I got a notice from Medicare to have a complete examination.

I assumed that Medicare would pay?

Then I get a bill from the insurance company that they refuse to pay the doctor for the examination??

It was the second time the bill had come. I had called the insurance company and they said it was a simple mistake and not to worry about it...

Today, I get the same bill again ??

I guess I will call them again?

[CousinIT]

15. And the RepubliCONS groused that government-run healthcare ..

.... was a DEATH PANEL?

The for-profit insurance industry has the market cornered on that business.

[dchill]

37. Irony is now potentially fatal.

[pecosbob]

16. Our health care system ensures that all Americans have the right

to ripped off by insurers and the health care industry and Pharma. Kinda makes you want to go start a commune in the desert.

[sarcasmo]

18. If the E.R. doesn't admit you, more than likely you're going to pay.

[KG]

19. but, the solution to shitty health care insurance companies was to force eveyone to buy it.

[PoindexterOglethorpe]

20. Insurance companies have always done this.

Not at all unique to Anthem.

[WhiskeyGrinder]

21. Doctors say over and over again that if you think you're having a heart attack, you should go to the

ER, every time. Especially for women -- any little weird thing, hit the ER. Why people are OK with private, for-profit companies getting between them and their doctor is beyond me.

[Ohiogal]

26. AMEN!!!!!

[Sam McGee]

35. And sometimes women . . .

. . . with a heart attack present differently from men.

Men typically experience crushing substernal chest pain.

Women may have the same crushing chest pain, HOWEVER, in many cases, women my experience severe back pain deep in the center of the back with only mild chest pain.

I'm an EMT. When I'm called for female with pain deep in center of her back, I first have her try to duplicate the pain -- that is, move arms, bend, reach, see if she can make the pain come or go. If not, or if it's inconclusive, I run an ECG. Heart attack damn near every time.

[GETPLANING]

22. Wait 'till someone dies when they should have gone to the ER

People have died from infections from something as simple as appendicitis. I fuckin' hate these people.

[PatrickforO]

23. Medicare for all Americans.

Medicare for all Americans.
Medicare for all Americans.
Medicare for all Americans.
Medicare for all Americans.
Medicare for all Americans.
Medicare for all Americans.
Medicare for all Americans.

NOW.

And, that is how I vote, and that is how I choose to donate. You running for office? Don't ask me for money unless you have this on our platform.

Yeah, I'll vote for you if you're a Dem and you DON'T support Medicare for all Americans, but I won't donate to you and I won't work for your campaign. And my vote will be grudging.

Because THIS IS A MORAL ISSUE, AND IT IS URGENT.

[pnwmom]

25. From the article, it's illegal, and here's where to appeal an illegal insurance co's decision:

https://www.healthcare.gov/appeal-insurance-company-decision/external-review/

[Ohioboy]

27. The first thing any insurance company does is try not to pay.

They are basically crooks. That's why single payer government health care is what is needed. We were working our way toward that at one time. Oh well.

[Demsrule86]

29. Yeah, had Hillary been elected we might have a public option.

[Demsrule86]

28. That has been going on for years. years ago we had a Prudential HMO who did this.

[Stardust1]

30. Disgusting

Call them what they are: murderers.

[Frustratedlady]

31. I was told by my cardiologist to go to the ER to have a possible TIA checked, today.

Anymore they are so backed up on appointments, the only way you can get in is to go to the ER. Medicare hasn't balked so far, but I'm waiting for it, as well as for ambulances.

[humbled_opinion]

33. Just one more

Great argument for Single Payer.

[Sam McGee]

34. I'm and Advanced Life Support EMT . . .

. . . and this is some bad shit.

So -- I'm dispatched at 2:00 AM for 72 year old male with severe crushing chest pain, shortness of breath. I get on the scene and find:
-- BP 210/110
-- Pulse 98 and thready
-- Respiration 20 and shallow
-- PulseOx 90%
-- Diaphoretic
-- Onset was 20 minutes ago -- he has 90 minutes from onset to balloon and I'm already 30 minutes into that

I run a 12-lead ECG and find confirmed STEMI with ST segments severely elevated and extended in four contiguous leads with PVCs in three leads.

I start an IV, put him on 6 L O2 via NC, and give him four 81mg aspirin followed five minutes later by the first of three nitro tabs.

I'm calling for a helicopter because I'm in a rural area with only a small general hospital -- medevac helicopter is $40,000. Medevac ETA is 20 minutes -- add that to the 30 plus 5 minutes to load and another 5 to transfer and another 20 back to the level one cardiac center, that's 30+20+5+5+20=80 minutes and he has only 90 until heart muscle damage sets in.

And some limp-wristed pencil-pushing insurance company clerk is going to second guess me??

The really is some bad shit.

[Skittles]

40. the idea that people need to self-diagnose

it goes against all advice given by doctors and firemen and EMTs - got chest pain? JUST WAIT, IT MAY BE NOTHING. I just don't understand how this kind of crap could be legal.

[Honeycombe8]

36. I THINK HMOs require you get authorization for that. BC sells mainly HMOs.

That's because ERs are very expensive.

I even have to be careful about going to an urgent care place.

They want you to go to your PCP, or get authorization from the PCP. If it's not working hours, though, you have flexibility. The dr isn't at work, so if you need attention, there's no possibility of going to your dr. at that time.

[3catwoman3]

39. One of my physician colleagues was listening to a webinar...

...during lunch last week. (I detest webinars.) It was BC/BS, and was about some new "guidelines" for one of their products - one of the more restrictive plans. One of the first things out of the mouth of one of the presenters was, "We're not going to tell you how to take care of your patients. You're already good at that."

They then went on to do just that. One of the "guidelines" was waiting 3 days before doing a throat culture if someone has a sore throat. That ain't never gonna fly with parents. When kids get home from school at 3 PM and mom goes thru the backpack and finds the note about "strep in the classroom," she panics, and asks the kid, "Does your throat hurt?" The kid, who may have had the early 10:45 AM lunch and hasn't had anything to drink since then, says yes because he/she is thirsty, not because it is really sore. Mom is on the horn 5 minutes later, wanting an appointment for a strep test RIGHT NOW! Not tomorrow, dammit, TODAY! Parents don't want to wait 3 hours, let alone 3 days.

This should be fun.