New Insurance Policy Expects Patients to Self-Diagnose

Imagine this. You wake up in the middle of the night with excruciating pain in your abdomen, pain bad enough that you are confident it requires an emergency room visit. You get to the hospital, and after multiple tests are done, the doctor tells you are suffering from ovarian cysts. After that, you receive treatment, and medication, and are able to head home for the night. At this point, you are thinking that everything is going to be okay, and any medical costs you may have incurred would be covered by your insurance company. It is now three weeks later, and you are hit with a $12,596 hospital bill because your insurance denied it, and now it all falls onto you. Sounds like a nightmare right? Well this is the reality for Brittany Cloyd, whose story we just imagined.

Anthem, a well known, and one of the country’s largest health insurance plans, denied the emergency room charges, therefore leaving it all onto Cloyd, and her family to pay. Anthem deemed the charges inappropriate because in their eyes Cloyd’s ovarian cysts were not “true emergencies”. According to Anthem, true emergencies are categorized as stroke, heart attack, and severe bleeding. These medical instances are when an ER visit would be acceptable. The worst part of it all is these denials are made after the initial emergency room visits. Policies like this are already rolled out in states such as Georgia, Indiana, Missouri, and Kentucky. These policies can deter patients from seeking needed emergency care because of the fear of medical debt.

This is why it is so important to read into every detail your insurance plan covers, and to bring awareness of this incident to your loved ones for future reference. If you need any help picking an health insurance plan that covers you, and your family in your times of need, please reach out to Dave Yaniro via email dave@integratedfinancialsol.com or give him a call (443) 794-3967.

Source: https://www.vox.com/policy-and-politics/2018/1/29/16906558/anthem-emergency-room-coverage-denials-inappropriate