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Letters to the editor Sunday: Shame on state’s largest health insurer

Anthem’s Blue Cross and Blue Shield of Georgia subsidiary should be ashamed.

The state’s largest health insurer is robbing its customers of the value and peace of mind they pay for and deserve, as the company now judges whether it will cover a patient’s emergency care after it has been provided.

This horrible policy forces patients, most of whom have no medical knowledge, to make potentially life or death decisions. Patients also might not seek emergency care if they face being stuck with a huge bill for MRIs, CT scans, etc. And Anthem makes these retrospective decisions using criteria that haven’t been made public.

As an emergency physician, I know that the average patient cannot always tell the difference between a minor or a life-threatening medical condition. And as Anthem customers, they shouldn’t have to.

As a member of both organizations, I was glad to hear that the Medical Association of Georgia (MAG) and the American College of Emergency Physicians (ACEP) have filed a federal lawsuit to compel Anthem to rescind this policy.

Anthem’s policy violates the “prudent layperson” standard, which is a federal law that requires insurers to cover the costs associated with emergency care based on the patient’s symptoms, not their final diagnosis. It also violates the Civil Rights Act because it disproportionately affects members of protected classes of people.

MAG and ACEP have repeatedly called for Anthem to rescind its policy to no avail. In addition, the insurer has refused to release the diagnostic codes it uses to identify diseases, disorders, symptoms, etc., for billing and claims purposes that are no longer covered as a result of this policy.

I encourage Anthem’s customers to find out what services the company will or won’t cover and how much money they will owe if it determines that the care they received wasn’t a “true” emergency. They can also call the Georgia Insurance Commissioner at 800-656-2298 to register concerns about this or other health insurance issues.

Anthem’s shareholders should get a reasonable return for their investment – and they clearly are based on the company’s earnings reports. But this policy crosses the line. It is immoral, it is illegal, and it undermines patient care.

Let’s hope that a groundswell of grassroots opposition, coupled with MAG and ACEP’s lawsuit, convinces Anthem/Blue Cross Blue Shield to do the right thing.

John L. Sy, D.O., MS, FACEP
Georgia Emergency Physician Specialists