All posts tagged consumer

Anthem asks Missourians to think twice before going to the emergency room – KCUR

Anthem Blue Cross Blue Shield, one of Missouris largest insurers, no longer covers emergency room visits that it deems unnecessary.

The policy aims to save costs and direct low-risk patients to primary care physicians and urgent care clinics. But doctors say patients may avoid going to a hospital when they really need it, if they fear a large bill.

Theyre forcing the lay public to make a medical determination, said Dr. Doug Char, a Washington University emergency physician. Theyre basically telling people you have to decide if this chest pain youre having is indigestion or a heart attack.

An emergency room is the most expensive place to see a doctor, and insurers are balking at the cost. Between 15 percent and 30 percent of emergency room visits in the St. Louis region are avoidable, according to a study by the nonprofit Midwest Health Initiative. Missouri hospitals charge an average of $372 for emergency room visits for minor issues, but some charge as much as $1,300, according to data compiled by the Missouri Hospital Association.

“Most non-emergent medical conditions can be easily treated at retail clinics, urgent care clinics or 24/7 telehealth services,” Anthem’s Missouri spokesperson, Scott Golden, wrote in an email. “The review by an Anthem medical director will take into consideration the presenting symptoms that brought the member to the emergency room as well as the diagnosis.”

In mid-May, Anthem sent letters to Missouri enrollees to alert them that from June 1, it would no longer cover emergency room services for non-emergencies. In such cases, people who have health insurance could still be stuck with the full cost of their visit, if the insurer determines that their symptoms did not reach the level of requiring emergency care.

Anthem enforces the same guidelines in Kentucky, and put the rule in place for Georgia policyholders this month. Its officials say there are several exceptions, such as if a patient is under 14, the visit occurs on a Sunday or there are no urgent-care centers within 15 miles.

The American College of Emergency Physicians raised a red flag when Anthem sent out a spreadsheet of 1,908 conditions that it may not deem worthy of coverage in an emergency room. Some of the listed symptoms could indicate a life-threatening emergency, said Dr. Jonathan Heidt, president of Missouris ACEP chapter.

To have them under that threat of not having their bills paid if theyre wrong about what their diagnosis is, its really going to harm patients in the long run, Heidt said. Our patients have a right to seek emergency care.

The doctors argue that Anthems policy, and similar rules set up by state Medicaid programs, violate the federal Affordable Care Acts prudent layperson standard. The rule asserts that a person with average knowledge of health and medicine should be able to anticipate serious impairment to his or her health in an emergency, and that laws should not assume that a person will know more than that. Anthem contends that it reviews claims using this standard already.

Though Anthem began enforcing the Missouri rule at the beginning of June, patients who visit the emergency room for non-emergencies likely will receive bills in the coming months. Heidt said that if Anthem does not reconsider its policy, ACEP may weigh legal action against the insurer.

Were still a little bit early for that,” Heidt said. “But at this time, all of our options are on the table.

According to the Missouri Department of Insurance, Financial Institutions & Professional Registration, the rule is based on previously filed language that was approved by the regulator. Other plans have similar provisions.

“If a consumer believes a claim has been improperly denied, or has questions about how a claim has been handled by their insurer, they can contact the Department’s Consumer Affairs Hotline at 800-726-7390 or they can file a complaint online,” said Grady Martin, the agency’s director of administration.

Follow Durrie on Twitter: @durrieB

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Anthem asks Missourians to think twice before going to the emergency room – KCUR

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Anthem asks Missourians to think twice before going to the … – St. Louis Public Radio

Anthem Blue Cross Blue Shield, one of Missouris largest insurers, no longer covers emergency room visits that it deems unnecessary.

The policy aims to save costs and direct low-risk patients to primary care physicians and urgent care clinics. But doctors say patients may avoid going to a hospital when they really need it, if they fear a large bill.

Theyre forcing the lay public to make a medical determination, said Dr. Doug Char, a Washington University emergency physician. Theyre basically telling people you have to decide if this chest pain youre having is indigestion or a heart attack.

An emergency room is the most expensive place to see a doctor, and insurers are balking at the cost. Between 15 percent and 30 percent of emergency room visits in the St. Louis region are avoidable, according to a study by the nonprofit Midwest Health Initiative. Missouri hospitals charge an average of $372 for emergency room visits for minor issues, but some charge as much as $1,300, according to data compiled by the Missouri Hospital Association.

“Most non-emergent medical conditions can be easily treated at retail clinics, urgent care clinics or 24/7 telehealth services,” Anthem’s Missouri spokesperson, Scott Golden, wrote in an email. “The review by an Anthem medical director will take into consideration the presenting symptoms that brought the member to the emergency room as well as the diagnosis.”

In mid-May, Anthem sent letters to Missouri enrollees to alert them that from June 1, it would no longer cover emergency room services for non-emergencies. In such cases, people who have health insurance could still be stuck with the full cost of their visit, if the insurer determines that their symptoms did not reach the level of requiring emergency care.

Anthem enforces the same guidelines in Kentucky, and put the rule in place for Georgia policyholders this month. Its officials say there are several exceptions, such as if a patient is under 14, the visit occurs on a Sunday or there are no urgent-care centers within 15 miles.

The American College of Emergency Physicians raised a red flag when Anthem sent out a spreadsheet of 1,908 conditions that it may not deem worthy of coverage in an emergency room. Some of the listed symptoms could indicate a life-threatening emergency, said Dr. Jonathan Heidt, president of Missouris ACEP chapter.

To have them under that threat of not having their bills paid if theyre wrong about what their diagnosis is, its really going to harm patients in the long run, Heidt said. Our patients have a right to seek emergency care.

The doctors argue that Anthems policy, and similar rules set up by state Medicaid programs, violate the federal Affordable Care Acts prudent layperson standard. The rule asserts that a person with average knowledge of health and medicine should be able to anticipate serious impairment to his or her health in an emergency, and that laws should not assume that a person will know more than that. Anthem contends that it reviews claims using this standard already.

Though Anthem began enforcing the Missouri rule at the beginning of June, patients who visit the emergency room for non-emergencies likely will receive bills in the coming months. Heidt said that if Anthem does not reconsider its policy, ACEP may weigh legal action against the insurer.

Were still a little bit early for that,” Heidt said. “But at this time, all of our options are on the table.

According to the Missouri Department of Insurance, Financial Institutions & Professional Registration, the rule is based on previously filed language that was approved by the regulator. Other plans have similar provisions.

“If a consumer believes a claim has been improperly denied, or has questions about how a claim has been handled by their insurer, they can contact the Department’s Consumer Affairs Hotline at 800-726-7390 or they can file a complaint online,” said Grady Martin, the agency’s director of administration.

Follow Durrie on Twitter: @durrieB

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Anthem asks Missourians to think twice before going to the … – St. Louis Public Radio

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Anthem asks Missourians to think twice before going to the emergency room – St. Louis American

(St. Louis Public Radio) – Anthem Blue Cross Blue Shield, one of Missouris largest insurers, no longer covers emergency room visits that it deems unnecessary.

The policy aims to save costs and direct low-risk patients to primary care physicians and urgent care clinics. But doctors say patients may avoid going to a hospital when they really need it, if they fear a large bill.

Theyre forcing the lay public to make a medical determination, said Dr. Doug Char, a Washington University emergency physician. Theyre basically telling people you have to decide if this chest pain youre having is indigestion or a heart attack.

An emergency room is the most expensive place to see a doctor, and insurers are balking at the cost. Between 15 percent and 30 percent of emergency room visits in the St. Louis region are avoidable, according to a study by the nonprofit Midwest Health Initiative. Missouri hospitals charge an average of $372 for emergency room visits for minor issues, but some charge as much as $1,300, according to data compiled by the Missouri Hospital Association.

“Most non-emergent medical conditions can be easily treated at retail clinics, urgent care clinics of 24/7 telehealth services,” Anthem’s Missouri spokesperson, Scott Golden, wrote in an email. “The review by an Anthem medical director will take into consideration the presenting symptoms that brought the member to the emergency room as well as the diagnosis.”

In mid-May, Anthem sent letters to Missouri enrollees to alert them that from June 1, it would no longer cover emergency room services for non-emergencies. In such cases, people who have health insurance could still be stuck with the full cost of their visit, if the insurer determines that their symptoms did not reach the level of requiring emergency care.

Anthem enforces the same guidelines in Kentucky, and put the rule in place for Georgia policyholders this month. Its officials say there are several exceptions, such as if a patient is under 14, the visit occurs on a Sunday or there are no urgent-care centers within 15 miles.

The American College of Emergency Physicians raised a red flag when Anthem sent out a spreadsheet of 1,908 conditions that it may not deem not worthy of coverage in an emergency room. Some of the listed symptoms could indicate a life-threatening emergency, said Dr. Jonathan Heidt, president of Missouris ACEP chapter.

To have them under that threat of not having their bills paid if theyre wrong about what their diagnosis is, its really going to harm patients in the long run, Heidt said. Our patients have a right to seek emergency care.

The doctors argue that Anthems policy, and similar rules set up by state Medicaid programs, violate the federal Affordable Care Acts prudent layperson standard. The rule asserts that a person with average knowledge of health and medicine should be able to anticipate serious impairment to his or her health in an emergency, and that laws should not assume that a person will know more than that. Anthem contends that it reviews claims using this standard already.

Though Anthem began enforcing the Missouri rule at the beginning of June, patients who visit the emergency room for non-emergencies likely will receive bills in the coming months. Heidt said that if Anthem does not reconsider its policy, ACEP may weigh legal action against the insurer.

Were still a little bit early for that,” Heidt said. “But at this time, all of our options are on the table.

According to the Missouri Department of Insurance, Financial Institutions & Professional Registration, the rule is based on previously filed language that was approved by the regulator. Other plans have similar provisions.

“If a consumer believes a claim has been improperly denied, or has questions about how a claim has been handled by their insurer, they can contact the Department’s Consumer Affairs Hotline at 800-726-7390 or they can file a complaint online,” said Grady Martin, the agency’s director of administration.

Republished with permission of St. Louis Public Radio: http://news.stlpublicradio.org/post/anthem-asks-missourians-think-twice-going-emergency-room

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Anthem asks Missourians to think twice before going to the emergency room – St. Louis American

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Anthem asks Missourians to think twice before going to the emergency room – KBIA

Anthem Blue Cross Blue Shield, one of Missouris largest insurers, no longer covers emergency room visits that it deems unnecessary.

The policy aims to save costs and direct low-risk patients to primary care physicians and urgent care clinics. But doctors say patients may avoid going to a hospital when they really need it, if they fear a large bill.

Theyre forcing the lay public to make a medical determination, said Dr. Doug Char, a Washington University emergency physician. Theyre basically telling people you have to decide if this chest pain youre having is indigestion or a heart attack.

An emergency room is the most expensive place to see a doctor, and insurers are balking at the cost. Between 15 percent and 30 percent of emergency room visits in the St. Louis region are avoidable, according to a study by the nonprofit Midwest Health Initiative. Missouri hospitals charge an average of $372 for emergency room visits for minor issues, but some charge as much as $1,300, according to data compiled by the Missouri Hospital Association.

“Most non-emergent medical conditions can be easily treated at retail clinics, urgent care clinics of 24/7 telehealth services,” Anthem’s Missouri spokesperson, Scott Golden, wrote in an email. “The review by an Anthem medical director will take into consideration the presenting symptoms that brought the member to the emergency room as well as the diagnosis.”

In mid-May, Anthem sent letters to Missouri enrollees to alert them that from June 1, it would no longer cover emergency room services for non-emergencies. In such cases, people who have health insurance could still be stuck with the full cost of their visit, if the insurer determines that their symptoms did not reach the level of requiring emergency care.

Anthem enforces the same guidelines in Kentucky, and put the rule in place for Georgia policyholders this month. Its officials say there are several exceptions, such as if a patient is under 14, the visit occurs on a Sunday or there are no urgent-care centers within 15 miles.

The American College of Emergency Physicians raised a red flag when Anthem sent out a spreadsheet of 1,908 conditions that it may not deem not worthy of coverage in an emergency room. Some of the listed symptoms could indicate a life-threatening emergency, said Dr. Jonathan Heidt, president of Missouris ACEP chapter.

To have them under that threat of not having their bills paid if theyre wrong about what their diagnosis is, its really going to harm patients in the long run, Heidt said. Our patients have a right to seek emergency care.

The doctors argue that Anthems policy, and similar rules set up by state Medicaid programs, violate the federal Affordable Care Acts prudent layperson standard. The rule asserts that a person with average knowledge of health and medicine should be able to anticipate serious impairment to his or her health in an emergency, and that laws should not assume that a person will know more than that. Anthem contends that it reviews claims using this standard already.

Though Anthem began enforcing the Missouri rule at the beginning of June, patients who visit the emergency room for non-emergencies likely will receive bills in the coming months. Heidt said that if Anthem does not reconsider its policy, ACEP may weigh legal action against the insurer.

Were still a little bit early for that,” Heidt said. “But at this time, all of our options are on the table.

According to the Missouri Department of Insurance, Financial Institutions & Professional Registration, the rule is based on previously filed language that was approved by the regulator. Other plans have similar provisions.

“If a consumer believes a claim has been improperly denied, or has questions about how a claim has been handled by their insurer, they can contact the Department’s Consumer Affairs Hotline at 800-726-7390 or they can file a complaint online,” said Grady Martin, the agency’s director of administration.

Follow Durrie on Twitter: @durrieB

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Anthem asks Missourians to think twice before going to the emergency room – KBIA

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The ER, an out-of-network provider and then ‘surprise!’ – mySanAntonio.com

Christopher Moriates and Victoria Valencia, For the Express-News

Photo: Mayra Beltran /Houston Chronicle

The ER, an out-of-network provider and then surprise!

Is there anything more emblematic of our troubled health care system than a patient receiving a surprise bill in the mail after getting emergency care?

The most egregious form of surprise medical bills, also known as balance bills, happens when an out-of-network provider bills a patient despite having delivered care at an in-network facility. Often this occurs when a patient goes to an emergency department or hospital that accepts that persons insurance, but then is seen by a physician who is not contracted with that insurance group.

As writer and physician Elizabeth Rosenthal recently wrote, Imagine if you paid for an airplane ticket and then got separate and inscrutable bills from the airline, the pilot, the co-pilot and the flight attendants. Even worse, the co-pilot could then tell you he is out of network and is going to bill you the full amount.

This practice of medical surprise out-of-network bills should be illegal. At this point, only the Legislature can solve the problem of surprise bills.

In 2009, Texas led the way by being the first state to put a mediation system in place for surprise bills. This past year, Senate Bill 507 was expanded to include mediation eligibility for bills of more than $500 from any provider type; facility bills from emergency care, including those from free-standing ERs; and to patients covered by the Teacher Retirement System, or TRS, health plan and the self-funded TRS ActiveCare program. This last change granted an estimated 680,000 additional individuals eligibility for the mediation process.

Prior to these changes, only bills from certain specialty providers were eligible for mediation, and ER facility bills were not eligible.

We should all thank our representatives for this bipartisan legislation, but it is nowhere near enough.

One indication the system is inadequate is how rarely it is used. A 2015 Consumer Reports survey found that 1 in 14 privately insured adult Texans reported getting a surprise, out-of-network bill within the previous two years, totaling about 250,000 Texans. However, according to the Department of Insurance, only 3,824 Texans have used the mediation process from its implementation in September 2009 through the end of last year.

Clearly, the system is not as accessible as it needs to be.

One major reason it is the responsibility of the patient to start the mediation process. This puts the onus on the patient to gather information, submit paperwork, make phone calls and attend at least one formal phone meeting. And that assumes the patient recognizes the bill is eligible for the process. Senate Bill 507 now specifies that when surprise bills are sent to patients, the sender must include language indicating the bill is the balance for out-of-network services and that it may be eligible for mediation. It is possible, however, that this language will be lost in all the other fine print on the mostly indecipherable bills.

Other states have passed much stronger protections than has Texas. New York passed a law in 2015 that requires hospitals negotiate directly with the insurer for all out-of-network payments, across all health care settings. This is how it should be.

Making the problem worse for patients, emergency departments in Texas can essentially charge whatever they want for services. Prices vary without any logic or reasonable guardrails. According to a recent study, emergency physicians reading an EKG (electrocardiogram) of your heart a mostly simple task performed many times each day charge patients anywhere from $18 to $317, which is 20 times the rate that Medicare would pay. If the doctor who read that EKG happens not to be in your network, guess who will be billed that full $317?

The Texas Legislature should consider capping all charges at a reasonable level above Medicare-allowable fees. There would still be variation in charges, but patients would no longer be subject to extreme markups.

Texas should lead once again in protecting patients from surprise medical bills.

Christopher Moriates, M.D., is assistant dean for health care value in the Dell Medical School at the University of Texas at Austin. Victoria Valencia is the assistant director for health care value in the Dell Medical School.

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7 of the Most Bizarre Reasons People End up in the Emergency Room – The Cheat Sheet

Emergency room staff see some crazy stuff, but you may be surprised to hear its not always the drama-filled scenes you see on TV. Theres a reason shows like Nurse Jackie and ER have such a loyal fan base, after all. A pill-popping ER nurse, fighting her own addiction, and a string of dramatic trauma cases are far more entertaining than patients with headaches and sprained fingers.

But the truth is emergency rooms tend to be a bit more low-key on a day-to-day basis they may even be weirder than you would think. Here are seven of the the most bizarre reasons people end up in the emergency room.

There are some fairly unusual reasons people visit the emergency room. Just take a look at this graph compiled by FlowingData, for instance.The data, which was collected in 2014 by the Consumer Product Safety Commission, shows just how random ER injuries can be. One worth mentioning has to do with ruining an otherwise perfect day of fun in the sun: Emergency rooms across the U.S. saw 1,231 beach chair-related injuries in June alone. Talk about spoiling a day at the beach.

Having any sort of reaction appear on your skin can be cause for concern. But theres no need to take it upon yourself to diagnose it as a much more serious disease, at least not before youve actually heard a doctors opinion.

One Reddit user said, I have patients who develop a rash, look it up on WebMD, and come to me screaming that they must have Stevens-Johnson Syndrome. Fast forward to the exam part of an ER visit, and the most common diagnosis is contact dermatitis from laundry soap. Reddit does go on to say, however, that although Stevens-Johnson syndrome is very rare, you should see a doctor immediately if you develop a rash after taking a new medication.

If that skin rash is due to contact dermatitis, theres no reason to panic. In most cases its not necessarily all that serious, and could even go away on its own. In fact, according to the American Academy of Dermatology, Almost everyone gets this type of eczema at least once. We get contact dermatitis when something that our skin touches causes a rash. Some rashes happen immediately. Most take time to appear. Irritants can include bleach, nickel, and latex gloves.

Foreign objects are a big one, and theres a wide range of them that can cause enough harm where an ER visit is in order. One Reddit usersayshe sees a lot of this one. Ear wax is NOT your enemy. It protects your ears it has antibacterial and antifungal properties, and is absorbent. Not a week goes by without a consultant for blood in the ear due to a Q-tip, or a ruptured drum from puncturing it with a foreign object, or a thermal injury from ear candling. It is NOT DIRT. So, you might want toease up on your cotton swabusage.

If youre cringing right now thinking about getting hooked, or hooking your friend in a not so pleasant place, know it is very possible. According to the American Academy of Family Physicians, fishhooks are right up there with splinters and glass. Most fishhook injuries occur in the hand, face or scalp, upper extremity, or foot, the organization says. Fishhooks in the eyelid or eye require immediate ophthalmologic referral. Just thinking about a hook in the eye is enough to send a person to the ER.

In the same vein, actually ingesting foreign objects can cause a well-deserved trip to the ER. While this may sound pretty ludicrous, it does happen.Vice polled a few medical professionals about some of the bizarre things ER docs see. In one response, the physician mentioned how those with mental health problems often engage in self-harming behavior. Unfortunately, it seems some emergency rooms are no strangers to people who consistently swallow harmful objects; knives, in particular.

Onehealthcare professional told Vice there are lots of well-known people who swallow knives, moving around from one hospital to the next. And interestingly enough, trying to remove such objects can be more dangerous than leaving them. The surgeons wont really operate on them unless theyve perforated some part of their gastrointestinal track, Vice explains. Sometimes they wont even operate on them anyways because theyre just going to do it again. So we just manage their symptoms. Ouch.

You dont often worry about grill tools being cause for concern, but the bristles on wire grill brushes have been known to get stuck on grills, resulting in transfer towhatever you happen to be cooking at the moment. While the numbers arent staggering, it does happen. Using data projections from the Consumer Product Safety Commissions National Electronic Injury Surveillance System, researchers estimate more than 1,600 ER visitswere a result of ingesting wire bristle grill brushes between2002 to 2014. Again, not staggering, but something to keep in mind.

BBQ-goers and chefs alike should be well-educated on the products theyre using. And according to Fox News, there are some precautions you can take to make sure you dont end up in the ER thanks to a bristle-loaded burger.

For instance, only use quality tools, thoroughly clean your grill and tools, and prepare the meat properly. And probably most importantly, make sure youre paying attention. Its easy to throw meat on the grill and walk away to socialize, but keeping a watchful eye on your meal can makea big difference.

Similar to our first point, this one also comes from FlowingDatas visual, which includes injury data collected by the Consumer Product Safety Commission. Injuries relatedbeds or bed frames comes in at No. 3 on the list. (If youre wondering what took the No. 1 and No. 2 spots, it was stairs/steps at 1,135,343 ER visits in 2014 and floors/flooring materials at 1,131,428 ER visits in 2014. But those two seemed a little less unusual, seeing as falling down stairs, or even tumbles due to slippery floors are quite common.)

Beds and bed frames accounted for 620,302 ER visits in 2014,which seems remarkablyhigh. It seemslike more of a user error issue, if you really think about it.

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7 of the Most Bizarre Reasons People End up in the Emergency Room – The Cheat Sheet

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