Anthem wants you to think like a doctor before visiting the ER...

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Patients are not physicians and should not be but Anthem Blue Cross/Blue Shield (BCBS) wants you to be one before you think about going to the Emergency Department (ED)….

Federal and many state laws protect patients from acting as a physician when it comes to expect that patients have the same knowledge as doctors.  For example, patients may have chest pain and are concerned and seek emergent care in the ED.  They often cannot distinguish their symptoms from a heart attack (myocardial infarction), tear in a major blood vessel (aortic dissection), collapsed lung (pneumothorax), infected gallbladder (acute cholecystitis), or just indigestion.  I am a practicing emergency physician with 25 years of experience and agree.  In fact, emergency physicians often cannot determine the seriousness of your complaints until other timely diagnostic tests (blood tests, x-rays, urinalysis, CT scans, ultrasounds, etc.) are performed.

Yet, Anthem Blue Cross/Blue Shield (BCBS) expects this from their patients!  Federal and state law has codified a “prudent layperson” standard for issuers to use when determining coverage of emergency medical treatment.  These laws are designed to protect patients by ensuring that their emergency care is covered by their insurer as long as this standard is met. 

Sen. Claire McCaskill, from Missouri, representing a state where Anthem implemented this policy, sent a letter to Anthem’s CEO requesting answers and internal documents from the company.  Likewise, the American College of Emergency Physicians (ACEP) launched a video campaign to educate patients about Anthem’s unsafe practice.

Instead of encouraging patients to seek timely care for an emergency, Anthem’s policy encourages people to wait at home and get worse or to ignore symptoms that may suggest a serious injury or illness.

Here is an example of a real patient and her plight with Anthem’s policy.  

Stop Anthem now!  Unless stopped, this could be go into effect in more states, with additional health insurance companies following with policies of their own.  This policy is currently practiced by Anthem in Georgia, Kentucky, Indiana, Missouri, New Hampshire, and Ohio.  That’s already 12% of the country!  Don’t let Anthem continue and add your state to the list.  It is the largest for-profit managed health care company in the Blue Cross and Blue Shield Association with reported revenues for 2016 of $85 billion.  Those benefitting from the money saved are the shareholders and executives.

Let’s stop Anthem from breaking the law!

If Anthem disagrees with your decision to go to the ER, they’ll deny you coverage. Stop this misguided policy! #FairCoverage.org #StopAnthemBCBs



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