MAG & ACEP file lawsuit against Anthem

The American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) have filed suit against Anthem’s Blue Cross Blue Shield of Georgia in federal court in an effort to compel the insurance giant to rescind its controversial and dangerous emergency care policy that retroactively denies coverage for emergency patients

Over the past year, Anthem implemented its policy in Georgia and five other states, leaving patients who sought emergency care responsible for paying their entire bills if the insurance company determined after retrospective reviews that their diagnoses were not truly emergencies. Along with Georgia, the other states include Indiana, Kentucky, Missouri, New Hampshire and Ohio.

According to the lawsuit, Anthem BCBS of Georgia’s policy violates the prudent layperson standard, which is a federal law requiring insurance companies to cover the costs of emergency care based on a patient’s symptoms – not their final diagnosis. The company uses a pre-determined list of undisclosed diagnoses to make its decisions. Additionally, the lawsuit contends that the company is also violating the 1964 Civil Rights Act because the denials disproportionally affect members of protected classes’ access to emergency care.

MAG reports that more than 70 percent of the physicians it polled in Georgia do not believe the average patient is knowledgeable enough to make judgments about what qualifies as a medical emergency.
According to a 2016 ACEP survey, one in four Americans said they had medical conditions that got worse after they delayed emergency care. 

The prudent layperson standard not only safeguards patients by requiring health insurers to base claims payments on a patient’s symptoms – and not their final diagnosis – it also prohibits those insurers from requiring patients to seek prior authorization before they seek emergency care. 

ACEP is encouraging patients who have had their health insurance coverage denied for an emergency to go to www.FairCoverage.org to share their stories. Georgians can also submit their concerns or complaints related to the Blue Cross Blue Shield ER policy to MAG at anthemerpolicy@mag.org.

Click to read lawsuit

MAG encouraging Georgians to act on BCBS ER policy

MAG is encouraging Georgians who have a Blue Cross Blue Shield of Georgia (BCBS) policy that they purchased through the federal ‘HealthCare.gov’ exchange to research how the insurer’s policy to review claims for emergency care on a retrospective basis affects them and their family members.  

MAG is encouraging affected Georgians to… 

– Contact BCBS at the ‘member services’ telephone number that is located on their ID card or log into their BCBS member account at bcbsga.com to confirm what services will or will not be covered under their policy and how much money they will owe if BCBS determines that the care they receive is not deemed an emergency.

– Schedule an annual wellness visit with a primary care physician to minimize the chance that they will need non-emergency care in an ER.

– Contact the Georgia Insurance Commissioner's office at 404.656.2070 or 800.656.2298 or click here to share their concerns or to file a complaint that is related to BCBS' ER policy. (Note that an online account must be created to submit an email).   

– Email any concerns and complaints that are related to the BCBS ER policy to MAG at anthemerpolicy@mag.org.