Anthem Emergency Room Coverage

Here you will find information for assessing coverage options guidelines for clinical utilization management practice policies the provider manual and support for delivering benefits to our members.

Anthem emergency room coverage. Anthem s emergency room coverage denials draw scrutiny paul sweatman s foot swelled up with a mystery bacterial infection in the fall of 2017 and an urgent care clinic told him to get to the. Urgent care centers are staffed with family pediatric er and internal medicine doctors. This means you don t have to sit in a waiting room while feeling miserable. Keep in mind that where you choose to get treatment will affect how much you pay always check if the urgent care is in your network.

Anthem a large health insurance company and some of its subsidiaries have introduced a restriction on emergency care coverage that could denying most coverage if the company later decides you. If you are enrolled in an individual anthem plan in new hampshire indiana or ohio you will soon be joining members in georgia missouri and kentucky who already have had to think twice before going to the er. Policies guidelines manuals we re committed to supporting you in providing quality care and services to the members in our network. Make sure you take your insurance card photo id and list of current medications.

Anthem blue cross blue shield the nation s largest health insurer is expanding its policy of not paying for emergency room er care that it decides was not an emergency. Seeking to address mounting concerns from providers and other stakeholders anthem has made changes to policies it previously rolled out that restrict coverage for emergency room visits. In recent years anthem has begun denying coverage for emergency room visits that it deems inappropriate because they aren t in the insurance plan s view true emergencies. Medical policies and clinical utilization management guidelines help us determine if a procedure is medically necessary.