Is It An Emergency? Anthem Makes Patients Question ER Visits.

[Cattledog]

Alison Wrenne was making waffles for her two young children one morning when abdominal pain forced her to the floor. A neighbor who is a physician assistant urged her to go to the emergency room.

Wrong decision, according to her health insurer. Wrenne was diagnosed with a ruptured ovarian cyst, but Anthem said that wasn’t an emergency and stuck her with a $4,110 bill.

“How are you supposed to know that?” said the 34-year-old from Lexington, Kentucky. “I’m not a doctor … that’s what the emergency room is for.”

ER Policy
In an effort to curb unnecessary and costly ER visits, the Blue Cross-Blue Shield insurer has told customers in a few U.S. states to go to the hospital only in a real emergency such as a heart attack, stroke and major bleeding — or they could wind up footing the bill.

Read it at:

https://www.wabe.org/emergency-insurer-makes-patients-question-er-visits/

[haele]

1. Yup, when spouse was having dizzy spells and fell out of his chair

Anthem Blue Cross refused to pay the ER bill and stuck us with a >$5K bill because they found a later diagnosis indicating it was his old meds no longer working that was causing his dizziness. Doesn't matter he had been having difficulties walking for less than a week and fell, hitting his head on the book-case, and possibly concussing himself as he blacked out...
He apparently should have immediately known to just stop taking those meds, and have his doctor to prescribe him new meds right away without fighting to get an emergency appointment and have all the possible lab results ready on hand before a day had passed.

Haele

[Angry Dragon]

2. BIG ASSHOLES

[Irish_Dem]

3. How in the heck do you know what is wrong until medical staff evaluate you? nt

[smirkymonkey]

4. This is just sick!

So people are now supposed to diagnose themselves before making a trip to the ER? It could be a fatal condition if you don't get help right away, but if it's not they are going to stick you with the bill.

[greymattermom]

5. So all ERs should have an urgent care adjacent to them

and someone to evaluate which one the patient needs. Patients can't make these decisions, only staff with medical training can.

[irisblue]

6. How did she know she was not having internal bleeding?

Dropping to the floor due to pain, that is a big problem. I truly hope she files complaints with her state insurance department, files company appeals, keeps making noise on TV & the papers.

[Ilsa]

7. A ruptured ovarian cyst laid me out,

and I know other women who required surgery and biopsy.

I hope BC/BS gets sued over someone ending up in a clinic when they needed emergency medicine.

[localroger]

8. Anthem needs to be sued, bigly, for practicing medicine without a license

This behavior is contrary to almost universal medical advice. A couple of years ago I had a false alarm thinking the old LAD might have been getting blocked again. (I got a spiffy new stent for my 50th birthday.) Turned out to be heartburn, and now I have a prescription for industrial strength Zantac as well as my blood pressure meds. Every single professional who looked at me assured me that I did the right thing by coming in. When something might be wrong, you don't fuck around with it, that's what the ER is FOR. Hesitating is a good way to end up dead if there is in fact a real problem.

[Cattledog]

9. I think insurance would rather have you dead than pay the bill.

[localroger]

10. If so, it's a really stupid business model

I pay about $6k per year in health insurance premiums. I've made exactly one trip to the ER, for the false alarm. Other than that I had the actual angiogram which was diagnosed by my cardiologist because I almost had a heart attack on the treadmill during a test. They have made far more from me in premiums than they have paid in claims, and that's likely to remain true for at least ten more years. And I don't mind that all that much; I have insurance through my employer, so the premiums are deducted from my paycheck and I get a reasonable rate. I would be squawking fiercely if an ER claim was denied based on this bullshit logic. If you don't want to be in the fucking insurance biz, don't pretend to be in the insurance biz. Being in the insurance biz means paying claims as well as collecting premiums.

[kacekwl]

11. Hey my fucking dumb republican representative told me

I could get my healthcare at the emergency room. WTF ?