Members of Congress and state regulators are pressing Anthem for additional information about how the policy works and which type of visits no longer receive coverage. They worry that other insurance plans may follow the lead of Anthem, a giant in the industry with more than 40 million members. “Anthem’s goal is to ensure access to high-quality, affordable health care, and one of the ways to help achieve that goal is to encourage consumers to receive care in the most appropriate setting,” the insurer said in its statement.Įmergency room doctors and patients argue that these new policies can often deprive patients of needed care and deter them from using emergency services in the future. Instead, the insurer provided a statement and declined to answer more specific follow-up questions. Luke Sharrett for VoxĪnthem initially agreed to an interview on its new policy and Cloyd’s case, but a spokesperson canceled the day before it was scheduled to take place. If you have one to share, you can submit it here.īrittany Cloyd at home with her husband Joshua, their daughter Aubrey, and their cat Railey. It relies on a database of readers’ own emergency room bills.
#ARE EMERGENCY ROOM VISITS COVERED BY MEDICAID SERIES#
The series has previously explored rising emergency room prices. Vox looked into Anthem’s practice of denying emergency room visits as part of a year-long project on emergency room billing. Beginning in July, Kentucky will charge Medicaid enrollees $20 for their first “inappropriate” emergency room visit, $50 for their second, and $75 for their third.Īll of these policies suggest a new and controversial strategy for reining in health care costs: asking patients to play a larger role in assessing their own medical condition - or pay a steep price. Indiana implemented this type of policy in 2015, and the Trump administration recently approved a request from Kentucky to do the same. The Anthem letter goes on to list “stroke, heart attack, and severe bleeding” as examples of medical conditions for which ER use would be acceptable.Īnthem’s new policy mirrors similar recent developments in state Medicaid programs, which increasingly ask enrollees to pay a higher price for emergency room trips that the state determines to be non-urgent.
when a health problem is recent and severe enough that it needs immediate care.” “Emergency room services can be approved. “We cannot approve benefits for your recent visit to the emergency room (ER) for pelvic pain,” the letter that Cloyd received from Anthem stated, which she shared with Vox. The policy has so far rolled out in four states: Georgia, Indiana, Missouri, and Kentucky. Share your bill here to help change that.
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