ER Patients Get Rude Awakening from Health Insurance Policy Denying Coverage
The last thing anyone wants to do is visit the emergency room. But when Americans are facing a crisis, ERs are critical for saving lives.
Now some ER patients are finding that insurance won’t cover these emergency trips when their visit isn’t deemed serious enough. And to make matters worse, it’s not a doctor making this determination – it’s an insurance company.
A recent article in Vox chronicles the impact of a new policy rolled-out by Anthem, in which ER visits must meet a list of “approved emergencies,” regardless of the symptoms involved – a detail that means a patient would have to diagnose herself before she visits the ER to know whether a trip potentially to save her life is covered. Vox profiled Brittany Cloyd of Kentucky, who went to the ER, doubled over in stomach pain, in fear of an appendicitis. When the diagnosis showed cysts instead, Anthem refused to cover her $12,000 hospital bill, since they did not consider cysts an “approved” condition.
So far, Anthem has introduced this policy in Georgia, Kentucky, Indiana and Missouri. Expect them to include more states, because limiting coverage increases their profit margins.
During the debate over Obamacare, a major concern was that patients without insurance were showing up in emergency rooms for non-urgent matters, filling up beds, over-working doctors, and driving up the cost of health care for everyone. Mandating insurance for all was supposed to “fix” this problem. But in fact, it’s just created another opportunity for insurance companies to increase their profits.
And the problem is obvious: patients with legitimate, severe symptoms may think twice before going to the ER, fearing a giant hospital bill if they’re wrong in their diagnosis. And, unfortunately for some of these people, it may be too late.
But what is insurance for if not for ER visits? Obamacare didn’t solve our ER problem – quite the opposite. Obamacare exacerbated the problem by forcing insurers now to cover too many expected, non-urgent costs, which is not the purpose of insurance. The end result is that insurers are forced to experiment with cost-saving efforts in order to avoid their most critical role as a backstop against unexpected costs like ER visits.
What’s more, as Hadley Heath Manning of the Independent Women’s Forum explained: the ER is still overused because now it’s difficult for Americans to get the preventive care they need. Medicaid patients can have an especially hard time finding primary care doctors who are willing to take on new patients. And the nationwide shortage of primary care physicians is made worse by the program’s low reimbursement rates. Obamacare expanded the Medicaid program, further exacerbating this problem.
The ER provides the convenience of taking ALL patients regardless of insurance or ability to pay, and no appointment is needed. There should be safeguards to prevent frivolous use of emergency rooms, but Anthem’s mistake is making the “punishment” for being wrong about an ER visit far too harsh. Their new policy risks discouraging real emergency needs from heading to the ER – a wrong and dangerous approach.