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Why some insurers are sticking patients with a big bill after an ER visit

Posted at 10:55 PM, Mar 06, 2018
and last updated 2018-03-06 23:21:39-05

Imagine you're very sick and head to the emergency room, only to later be told by your insurance company that it wasn't a true emergency. Even worse.. you're now responsible for the bill. A new investigation from Consumer Reports finds more and more patients are getting stuck with big surprise bills from the ER.

Many health insurance company try to discourage costly emergency-room care, by charging a higher copay for ER visits, compared with urgent care centers or walk-in retail clinics. But some consumers have complained that Anthem have billed for ER visits, saying consumers should have called the company’s 24/7 online doctor service, or gone to her own doctor or urgent care. Consumer Reports say policies like Anthem’s are leaving consumers with huge medical bills, and could keep patients from going to the ER when they should. 

How can you make sure this won’t happen to you? CR says the first step is to understand your insurance. Check your insurer’s “emergency service benefits” coverage to see how it defines an emergency and what your plan will and won’t cover. While most insurers offer general guidelines as to what constitutes an emergency, they don’t limit policy holders to specific injuries or illnesses. And if you’re insurer rejects a claim, file an appeal.

Anthem told Consumer Reports that it is simply trying to rein in the overuse of ERs for minor problems. The insurer says the ER is a time-consuming and costly place to get care that could be handled elsewhere. Anthem has many exceptions to their ER policy, such as if a patient is under the age of 15, and if they were told to go to the ER by their doctor. You can find more about Surprise Medical Bills at