Anthem extends its discretionary coverage for ER visits to Missouri


Anthem Blue Cross Blue Shield of Missouri will no longer cover emergency department services it considers unnecessary, according to St. Louis Public Radio.

The goal of the discretionary ED coverage policy is to direct non-emergent patients to urgent care or primary care physicians to reduce costs and emergency room wait times.

In these nonemergency situations, policyholders could foot the bill if their visit does not meet emergency requirements.

The policy has several exceptions, including if the patient is under 14, the visit occurs on Sunday or there are no urgent care clinics within 15 miles, according to the report.

Similar policies are enacted in Kentucky and Georgia under Anthem-affiliated plans.

“We are looking to expand the policy to other markets, but we have not brought it to other states yet,” Anthem’s Public Relations Director Joyzelle Davis told Becker’s Hospital Review.

Physicians are worried that the policy may cause patients to shy away from seeking care when they need it since there is a threat of receiving large medical bills, according to the report.

In Kentucky, where the policy has been in place since 2015, Ms. Davis said the insurer has only issued denials for a “small percentage” of claims for unnecessary ER use, but the number of members with “repeat avoidable ER claims” has declined.

 

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