Anthem among health insurers refusing to pay ER bills

[somarco]

I know of a situation with an ovarian cyst just as described above. Two ER visits over a couple years. Then the final one was the cyst burst, twisted the ovary and emergency surgery was required. The pain is like appendicitis, not a joke. I hope they prevail if they appeal.

Per the link above . . .

Brittany Cloyd lost her first appeal, but she refused to take no for an answer. So she sent Anthem a second appeal with documentation and a rebuke.

"I'm not sure how one knows if they're bleeding internally," she wrote. "But I hope that it's apparent … perpetuating scare tactics could certainly convince patients not to go the emergency room. I foresee an onslaught of wrongful death suits in Anthem's future."

Cloyd said Anthem then paid her entire $12,596 ER bill.

 

[yorkriver1]

Per the link above . . .

Brittany Cloyd lost her first appeal, but she refused to take no for an answer. So she sent Anthem a second appeal with documentation and a rebuke.

"I'm not sure how one knows if they're bleeding internally," she wrote. "But I hope that it's apparent … perpetuating scare tactics could certainly convince patients not to go the emergency room. I foresee an onslaught of wrongful death suits in Anthem's future."

Cloyd said Anthem then paid her entire $12,596 ER bill.

Thanks, Bob, good to know. The one I described above was some years ago, and no known payment issue. One ER refusal from a few years ago I had to work on for a client was a wrongly coded ER bill, and I had to speak with the hospital billing department and Anthem to get answers. I get the need to curb ER use, but I think softer up front education tactics and as someone else said, maybe stop with the lower ER copays. I notice that hold messages with some carriers alternate between the ER message and one about not taking antibiotics for viral illness. I think hospitals should divide the ER into an urgent care unit and ER, to triage the cases.

 

[OregonDave]

Should have sold her prepaid legal services with her anthem plan.

 

[ABC]

I have first hand experience with anthem and ER claims being denied.
I'm 5-1 on winning appeals.
The claims are being denied based on what the physicians are submitting from a code standpoint. There are diagnosis codes that are not supported by ER admissions. Based on most PPO contracts, the medical provider has to write it off because they were in error. Tell all of your clients, if they go to ER don't sign anything without reading it and understanding.

The one I lost, the Facilty had to write it off base on their ppo contract.