Anthem’s Emergency Department Policy

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Earlier this year, Anthem Insurance Companies, Inc. announced that it will be reviewing their members’ emergency department visits. If the condition they are being seen for is deemed non-emergent, Anthem may not cover the ED visit. “Anthem States” cut a wide swath. Those affected are members in CO, CT, NV, GA, IN, KY, MI, MO, NH, OH, VA, and WI. This research looks at how this new policy will affect providers and patients in the affected states as well as feedback from providers in other states across the country.

Who Responded?

Results are compared across two participant groups. The first is based on whether or not a respondent resides in a state where Anthem’s policy is being rolled out. Second is based on title, ED leadership vs physicians.

Impact On Hospitals

Across the board there’s a negative tone for Anthem’s policy. “I don’t feel any insurance company has the right to say if a patient has an emergency or not…” just one of many comments from ED physicians and department leaders.

Is this a Trend?

One of the concerns that emerged from the research is that payers will follow suit. Again, different groups vary slightly, but still over 50% of respondents think this will expand into their state.