POSTED: October 9th, 2017
POSTED IN: September/October 2017,
Even though the weather is beginning to cool down in Missouri as we have entered the fall season, the work at MOCEP is just starting to heat up! Even though we are off cycle with my quarterly president’s message, I wanted to provide you with a brief update on our work as we confront Anthem’s new policy on denying “non-emergent” emergency department visits.
As a reminder, in June, Anthem notified their participants that non-emergent ED visits would no longer be covered by their health plans. After denial, the patients could be expecting to be transitioned to “self-pay” status for that ED visit. We were able to obtain a list of nearly 2000 ICD-10 codes that Anthem considered to be non-emergent. Anthem claimed that the prudent layperson standard would be met as they would review medical records with one of these diagnoses to determine if the patient could have reasonably believed he or she was having an actual emergency. As we all know, that would be nearly impossible to determine from only reviewing an ED note. Regardless, we have been receiving reports that Anthem is not requesting medical records for the denied claims and they are denying claims that would have met one of their exclusion criteria – weekend, holidays, proximity to an urgent care, etc. We even have one report of them denying a claim on a patient that was admitted to the hospital!
Since I last submitted an update on this issue, we have pressed forward with the following strategy:
1) Discuss with media and educate the public – We have had a couple of stories printed in the St. Louis Post-Dispatch. I have spoken with an AP reporter, and plan on speaking with a NY time reporter soon. We recently also participated in a radio show called “Top Docs” to discuss the issue (https://www.spreaker.com/user/cwhall3/er-physicians-discuss-new-blue-cross-blu). We are closely working with ACEP to develop further press releases.
2) Collect data on the impact in Missouri – in conjunction with our partners at MHA, MSMA and MAOPS, we have recently released a website with the goal of collecting both patient and physician stories on the impact of this policy. Please visit this website and share your own stories (https://missourihealthmatters.com/tell-us-anthems-emergency-care-coverage-policy-harmful/). We are also working EDPMA to collect data on the number of claims being denied in Missouri.
3) Legislative and regulatory discussions – We have recently met with Senators Blunt and McCaskill’s offices to discuss this policy and received promising feedback. We will also be meeting with the Missouri Department of Insurance later in October.
This issue continues to quickly evolve and has kept us quite active. Please know that MOCEP is working tirelessly on behalf of ED physicians in Missouri and all of our patients. If you have any questions, please do not hesitate to contact me at Jonathan@mocep.org.
Jonathan Heidt, MD, MHA, FACEP