Can Your Insurer Retroactively Deny Coverage for "Avoidable" ER Visits?
WRITTEN BY
s.e. smith , Care2
PUBLISHED
June 6, 2018
Visiting the emergency room is expensive, and a whole lot of Americans hit the ER every year – with some critics claiming that many of these visits are unnecessary.
In fact, one insurer thinks it’s come up with an excellent way to addressing this issue: Anthem refuses to pay for visits it deems “avoidable.” And that can leave some patients holding very large bills.
The way people utilize emergency departments can be complex. For people who are underinsured or uninsured, the ER may be seen as the best way to quickly access treatment. For those with good insurance coverage, poor communication about access to urgent care — which provides appointments quickly within regular work hours — can be an issue. At other times, long waits for available appointments may push people to the ER, as well as the lack of a triage line to help people decide if something is an emergency.
But sometimes, a genuine emergency arises — or the symptoms are such that they could indicate a crisis, but you won’t know until you get evaluated. For example, someone experiencing severe chest pain might be having a life-threatening myocardial infarction — or severe anxiety or heartburn.
More:
https://truthout.org/articles/can-your-insurer-retroactively-deny-coverage-for-avoidable-er-visits/
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