More health insurers are refusing to pay ER bills

[Yo_Mama_Been_Loggin]

On Aug., 1, 2017, Brittany Cloyd of Frankfort, Kentucky, said she experienced pain "worse than childbirth." Her mother -- who had been to nursing school -- drove her to the nearest emergency room. Brittany thought her appendix had burst, but tests at the ER found she had ovarian cysts. She was given pain medication and told to follow up with her primary doctor.

Cloyd had an Anthem Blue Cross PPO health insurance plan and thought she would get charged just a co-pay for her ER visit. Instead, 15 days later she received a letter from health insurer Anthem. "Your condition does not meet the definition of emergency," read the letter. She was responsible for the total ER bill -- $12,596.

What Brittany endured is becoming more common in the health insurance industry, according to a Doctor Patient Rights Project (DPRP) study. It highlighted Anthem, which through its affiliated networks is the nation's largest private health insurer. The DPRP contends that Anthem has instituted an organized policy of denial designed to make its subscribers -- particularly those who are poor and reside in rural areas -- too afraid to go to an ER for fear of receiving a bill like Cloyd's, or more, for the visit.

"The purpose of this program is to spread fear," said Dr. Ryan Stanton, a critical care and emergency medical specialist in Lexington, Kentucky.

https://www.msn.com/en-us/money/healthcare/more-health-insurers-are-refusing-to-pay-er-bills/ar-BBQ9I9m?li=BBnbfcN

Interesting. I have Anthem BCBS and was in the hospital for two weeks in July because of a subdural hematoma. The surgery, hospital stay and subsequent physical therapy came out to six figures. I had to pay about $5000 of that.

[madaboutharry]

1. People will die.

Someone suffering chest pain won’t go to the ER because unless it’s a heart attack they know the bill will be denied. It’s criminal.

[blueinredohio]

12. Funny you said that. I also have Anthem.

This summer I would have indigestion so bad I couldn't eat. It would make my chest hurt. One day the pain radiated to my shoulder and left side of my neck which scared me as I am 61 years old so I went to the E.R.
They found nothing and Anthem said they wouldn't pay because I didn't go within 48 hours of getting the pain. I appealed the decision, told them exactly what I thought of their decision. Long story short they ended up paying for it.

[madaboutharry]

14. They try to bully people.

This issue speaks volumes of what this country really values: $$$$$$

[ck4829]

23. Feature, not a bug, of the 'world's greatest healthcare system'

[dem4decades]

2. For profit health care is criminal.

[Zing Zing Zingbah]

3. That's ridiculous

Someone should sue the insurance company for this. Even the if person wasn't at risk of dying any time soon, how can they expect regular people to know that? They can't diagnose themselves.

[Zing Zing Zingbah]

4. Wondering what would happen if someone called their doctor's office

and they were instructed over the phone to go to the ER.... then the insurance company does this.

I'm thinking they are trying to get people to go to walk in clinics more, but in my area they actually closed one of those up and they tell people to go to the ER instead.

[Guppy]

5. Anthem BCBS

owns 14 blues. There are 38 blues in country. Anthem is quite bad but they all are. There is a major lawsuit against all the blues by patients and Doctors for price fixing. It has been going on for about 4 years. I know it very well.

I spoke to the attorney who wrote the motion to dismiss. Believe it or not the U.S. district judge was out of Birmingham, Al where the case is being litigated. That is because Blue cross has a 95% share of the healthcare market in Alabama.

That judge who was a bush appointee ripped that attorney a new asshole.

[area51]

6. Barbaric.

Most people are one medical incident away from bankruptcy. We need Medicare for All now!

[MineralMan]

7. I think Blue Cross Blue Shield expects you to call

their "Nurse Line" for non-life-threatening emergencies. That's what I remember from when I was a BC/BS member. The nurse would ask you some questions and then recommend what you should do.

Now, if you call 911 or go to the emergency room, and what's going on warrants an ER visit, you're covered. But if it doesn't, whether you called the nurse line in advance or not may play into whether you're covered or not.

I will say this: The times when I or my wife called the nurse line, the service was excellent and the advice good. In most cases, there is no emergency, and you are told to wait for a period of time and call back. If you called and it was a genuine emergency, you got told to call 911 or go immediately to the ER. Some simple diagnostic checks that can be done by the patient are used, and then it's the nurse's call after that.

It's a good service. It can save people unnecessary trips to the ER, and often allay fears. One time, my wife had severe abdominal pain, and after the nurse line had her do a couple of things to check for abdominal tightness and other issues, she was told to wait an hour and call back if the problem didn't get better. It got better after she passed some gas, actually.

[PoindexterOglethorpe]

27. That's an excellent system.

There should be a "Nurse Line" that's available to all, not just the subscribers to a specific plan.

[MichMary]

8. Sometimes all it takes is a letter

I have done it a number of times.

My son got a compression fracture in his spine, and the back brace was coded as an "orthotic device," or something and the insurance company refused to pay. I wrote a letter and explained the situation, and the alternative to a brace (which, I believe, would have been hospital bed for weeks or more, physical therapy from the resulting inactivity, etc.) and they paid up.

Things happen, and there are ways to correct them.

[Cousin Dupree]

18. No, there are not ALWAYS ways to correct them. Sometimes patients just get the shaft.

[ck4829]

25. Indeed

[Kaleva]

9. The nearest VA hospital is too far away for emergency calls....

and I get really worried when told by the VA to go to the nearest local hospital because one time the paperwork wasn't processed correctly and it took me two years to pay that ER visit. The last time I went, I was laying in the bed in the ER, in serious pain, and on the phone with the VA making sure everything was in order.

[Ilsa]

10. The pain from an ovarian cyst can easily be

Misunderstood as a critical condition. It feels like a knife stabbing you. And yes, it can be an emergency if it is a huge cyst that needs to be drained and packed. Surgery may be required.

The MBAs making these decisions are greedy idiots.

[SharonAnn]

15. I had that happen several times over 10 years. Finally diagnosed as appendicitis.

When it was removed, doctor said it had obviously been a problem for a long time, and it started to fall apart as he removed it. Asked about the history so I told him. Had gone to the ER in Dayton, OH, Atlanta GA, Los Angeles, CA, then again in Dayton. Happened about every 2 years and yes, I was transferred a lot during those years.

Problem was there would be acute pain and nausea and then it would subside within 5-8 hours. Didn't have high fever or elevated WBC, classic signs that usually go along with appendicitis attack.

The last time the pain stayed, they admitted me, surgeons review in the AM was that it was not appendicitis. Then 6 hours later the pain changed, fever spiked, WBC went way up and the same surgeon said it was "classic appendicitis", and he removed it. No problems like that for the last 35 years.

[LastDemocratInSC]

17. My wife is an ICU nurse. When she had an ovarian cyst rupture the pain was so severe she thought

it was an abdominal aortic aneurysm. She knew it could be a cyst rupturing but the pain was off the charts. She has the experience to know when it's time to get to the hospital. We called 911 immediately and she was in the ER within 25 minutes.

[Hermit-The-Prog]

11. wealth care system learned from legal system

The purpose of our current wealth care system is to extract as much from its prey as possible before death. It learned this from our legal system, except the legal system is far too slow and inefficient at extracting resources.

Sensible health care: Are you human? C'mon in.

Current wealth care system: How much do you have to spend?

[Demovictory9]

13. medical bills are ridiculous made up nonsense

[Vinca]

16. People should appeal and if that doesn't work try going to the state insurance commissioner.

A few years ago - before I was on Medicare - insurance refused to pay for a colonoscopy. I appealed, got nowhere and sent a last letter telling them I was filing a complaint with the insurance commission. The insurance company paid.

[Yo_Mama_Been_Loggin]

19. A colonoscopy is supposed to be preventitive care per Obamacare

I had one two years ago and it didn't cost me a thing. Or was yours before this took effect?

[Vinca]

21. Believe it or not I was in the Obamacare pre-existing condition pool.

Apparently they objected because the doctor didn't code it as a routine screening, but as a follow-up (he'd done them before for me). In any case, it was an annoyance but it finally was sorted out.

[shanti]

22. I have Kaiser

and I had a colonoscopy about 2008. I had to fight for it though! My GP said I only needed one of those mail-in tests, but I wrote a letter to Kaiser's business office protesting it, and they did eventually approve it. I dumped my GP after that.

Sometimes, you really do need to fight for your rights!

[McCamy Taylor]

20. Captain Hindsight works for the health care industry.

[ck4829]

24. Kick

[dubyadiprecession]

26. Trumpster's are ignorant about consumer protection....

The healthcare industry, like all other large corporations, do whatever they want when republicans are in control. They get rid of those pesky regulations, and these dumbshits in places like Mississippi enable them.

[octoberlib]

28. If you have severe abdominal pain that

lasts more than 12 hours , doctors advise you to go to the emergency room. How would Brittany Cloyd know it wasn’t life- threatening unless she got it checked out?