WASHINGTON -- U.S. Sen. Claire McCaskill is calling for a full review of the actions by health insurer Anthem to deny emergency room coverage for Missourians' care if deemed non-emergent - a potential violation of consumers' rights and federal law.
"We remain concerned that Anthem's (emergency department) policy still forces patients to determine, before they even leave their home, if their symptoms are serious enough to go to the emergency room," wrote McCaskill and Sen. Ben Cardin, of Maryland, to the Secretaries of Health and Human Services, and Labor. "The Prudent Layperson Standard was specifically drafted to allow patients to get the services they need, when they need them. Patients should not be forced to act as their own doctors and second guess themselves when they truly believe that they are having a medical emergency. Anthem's coverage denials are creating obstacles to emergency room care and are leaving patients responsible for thousands of dollars in medical bills."
McCaskill's letter outlines Anthem's potential violation of federal law by disapproving emergency room claims that may be required to be allowed under the Prudent Layperson Standard, a law that requires emergency room coverage where absence of immediate medical attention would place the health of the individual in serious jeopardy.
McCaskill is demanding answers from Anthem after the insurance company announced it would no longer cover emergency room costs for Missourians if they deem the care "non-emergent." Last month, healthcare and emergency room costs in Missouri and across the country were the focus of a roundtable discussion with McCaskill, emergency room doctors, patient advocates, and community health workers in Kansas City.
Last year, McCaskill sought answers from Envision Healthcare and its subsidiary, EmCare Holdings Inc., following reports of skyrocketing costs at emergency rooms run by EmCare. According to those reports, EmCare tripled the highest rate for ER visits at one hospital that was studied and allegedly pressured ER doctors to order expensive, unnecessary tests for patients. EmCare manages more than 10 hospitals in Missouri.