MAG ‘Top Docs’ show on Anthem ER policy now online    

The latest episode of the Medical Association of Georgia’s (MAG) ‘Top Docs Radio’ show – which addresses the new Anthem/Blue Cross Blue Shield of Georgia policy to reject claims for care that patients who obtained their insurance through a federal ‘HealthCare’ exchange plan receive in an emergency room if it retrospectively determines it was not an emergency – is now available online.

The show features John Rogers, M.D., who is an emergency physician from Macon and the chair of the Board of Directors of the American College of Emergency Physicians (ACEP), and Jonathan Heidt, M.D., the president of the Missouri College of Emergency Physicians.

Dr. Rogers reports that, “More than 70 percent of the physicians who completed a recent MAG survey said they do not believe the average patient is knowledgeable enough to make judgments about what qualifies as a medical emergency.”

MAG Executive Director Donald J. Palmisano Jr. adds that, “Blue Cross, which is the state’s largest health insurer, has failed to respond in writing to MAG’s requests for the data it used as the basis for this policy – and it has refused to release the diagnostic codes that are used to identify diseases, disorders, symptoms, etc. for billing and claims purposes that will no longer be covered under its new policy.”

The American Medical Association has called for Anthem to “rescind this policy in states where it has taken effect, and halt implementation in all other states.”

And ACEP and its Georgia chapter believe the new policy violates the “prudent layperson” standard – which is codified in federal law, including the Affordable Care Act – that requires insurance policies be based on a patient’s symptoms, not their final diagnosis.

“Due to uncertainty within the health insurance market, insurers have begun to develop strategies to control costs,” explains Dr. Heidt. “One area of focus is emergency department utilization. There is a common belief that many patients frequently use emergency services for non-urgent conditions which could have been treated in a lower cost setting, but this assertion is based upon patients’ final diagnosis rather than presenting symptoms.”

He also emphasizes that, “Many emergent and non-emergent diagnoses share the same symptoms and can be difficult to distinguish prior to evaluation in the emergency department. For example, chest pain can be the presenting symptom for simple heartburn or it could be the onset of a heart attack.”

MAG sponsors the ‘Top Docs’ program twice a month. Between downloads and live listeners, it has now reached more than 22,000 listeners – which includes people in all 50 states and 84 countries.

MAG’s ‘Top Docs Radio’ show is supported with a grant from Health Care Research, a subsidiary of Alliant Health Solutions.

Listen to "ER Physicians Discuss New Blue Cross Blue Shield Policy on MAG's Top Docs Radio Show" on Spreaker.