Ohio Lawmakers Target Anthem Over ER Policy

Columbus Dispatch, Ohio

Feb. 22--Three state lawmakers are calling on elected officials to penalize Anthem Blue Cross Blue Shield for making a coverage change that denies claims for what the insurer says are non-emergency visits to the emergency room.

State Rep. Alicia Reece said at a Wednesday news conference that she and the other lawmakers plan to draft a bill that would exclude any insurer that implements such a policy from tax breaks as well as contracts to cover state, county or city workers. She was joined by state Rep. Stephanie Howse, a Cleveland Democrat who presides over the Ohio Legislative Black Caucus, and state Rep. Thomas West, a Democrat from Canton.

Reece, a Cincinnati Democrat, said she was devastated to hear about Anthem's policy change, which went into effect in Ohio at the start of the year.

"We don't buy insurance for the insurance company to be the doctor. We don't buy insurance for the insurance company to be the surgeon," she said. "I'm looking for the experts to tell me what's wrong with me."

She and the others also will call on Gov. John Kasich to intervene and ask Attorney General Mike DeWine to investigate whether the change violates any laws.

It is feared that patients with symptoms of a heart attack or other serious illness will hesitate, perhaps Googling symptoms to self-diagnose, before heading to an ER because they can't pay a massive medical bill and still put food on the table.

"That split second can make a difference between life and death," Reece said.

There also are concerns that Anthem is not reducing insurance rates for the reduction in coverage; that patients will be left on their own to negotiate uncovered health-care costs with hospitals; and that uncovered costs could bankrupt families and individuals, leaving them unable to pay taxes or contribute to the economy.

Reece said she's also concerned that other insurance providers will follow suit.

"It's too dangerous and too reckless, and too many people will be affected by it," she said.

Indianapolis-based Anthem has 3.5 million health-insurance customers in Ohio. The company also implemented the change in Indiana and New Hampshire at the start of the year and before that in Missouri, Georgia and Kentucky.

Jeff Blunt, an Ohio-based spokesman for Anthem, said patients should always call 911 or go to the ER if they feel they have an emergency. When a patient uses an emergency room when a more appropriate setting is available, the claim will be reviewed, he said.

"Anthem's ER program aims to reduce the trend in recent years of inappropriate use of ERs for non-emergencies," he said in statement. "For non-emergency health-care needs, ERs are often a time-consuming place to receive care and in many instances 10 times higher in cost than urgent care."

Emergency visits will always be covered if a patient is directed to the ER by a health-care professional, including an ambulance provider; if the patient is younger than 15; if the patient lives more than 15 miles from an urgent-care center; if the patient is traveling; or, if the visit occurs on a major holiday or between Saturday night and Monday morning.

Visits also will be covered if they are billed as urgent care or are associated with an outpatient or inpatient admission; or if the patient receives surgery, IV fluids or IV medications, or an MRI or CT scan.

The lawmakers said Wednesday that they hope to talk with Anthem in an effort to protect both the company's business interests and the health-care needs of Ohioans.

"We are open and willing to have continuing dialogue," Howse said. "We will not stand idly to the side and see the changes and the company taking advantage of individuals and putting them at financial risk and, more importantly, putting their lives at risk."

jviviano@dispatch.com