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Study: Anthem's 'retrospective denial' policy for emergency care puts patients at risk

from Fierce Healthcare

Anthem's policy of "retrospectively denying" emergency department claims has sustained a barrage of attacks from providers, and a new study is giving further weight to those criticisms with evidence that the policy risks discouraging all ER visits, even true emergencies. The study, published last week in JAMA Network Open, found that based on a review of ED diagnoses between 2011 and 2015, one in six commercially insured adult ED visits would be classified as "nonemergent" under Anthem's policy. Those denial diagnosis visits shared the same symptoms as 88 percent of commercially insured adult ED visits. "This cost-reduction policy could place many patients who reasonably seek ED care at risk of coverage denial," the study authors wrote. more

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