Anthem Stops Paying for Non-Emergency ED Visits: 4 Takeaways

From Managed Healthcare Executive:

4. More states are likely to be affected.

Trembowicz predicts that Anthem will extend its policy to more states. “It will most likely be adopted in states with fewer consumer protections beyond the insurance contract,” he says. “In states with more extensive consumer protections (e.g., unfair or deceptive acts or practices statutes), or more activist insurance regulators, the insurer may be required to obtain and review the full medical record to understand symptoms and conditions present on admission, and not just rely solely on information in the claim before adjudicating the claim, which is a more expensive process.”

 

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