AMA calls for Anthem to rescind ER policy

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American Medical Association Executive Vice President and CEO James L. Madara, M.D., has sent a letter to Anthem, Inc. President and CEO Joseph R. Swedish to share AMA’s concerns about “Anthem’s policy in several states (including Georgia) to deny coverage of many emergency services when the diagnosis is retrospectively determined not to have required emergency care…(and to) ask that Anthem rescind this policy in states where it has taken effect, and halt implementation in all other states.”

In his June 29 letter, Dr. Madara stresses that, “The impact of this policy is that very ill and vulnerable patients will not seek needed emergency medical care while, bluntly, their conditions worsen or they die…[the policy] also reduces the value of health insurance policies on which patients have spent thousands of dollars to have access to care, including emergency care.”

Dr. Madara also points out that “Anthem’s policy may be in conflict with federal patient protections. Federal law requires that if group health plans and health insurers cover any care in the emergency department, then they must cover emergency services for emergency medical conditions as defined using a prudent layperson standard…[AMA is also] concerned that Anthem’s policy may be in conflict with many state laws, including those in Georgia…”

MAG members can contact Kimberly Ramseur at kramseur@mag.org with questions related to the Anthem policy. 

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