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We Want You to Know About a Change in Our Emergency Room Program in Kentucky

February 14, 2018

Recently we launched a program to help address the rising trend of emergency room use for non-emergency health concerns. This program encourages people to use primary care doctors, urgent and retail clinics, and telehealth options instead of the ER. We recognize, however, that there are ways to further improve and enhance the program, and we’re committed to making it better. Here is how we are doing that:

  1. We expanded our list of “always-approve” exceptions. That means we will take that new list of exceptions and look back at claims that were previously denied. If one of those conditions was present, we will change the decision and pay the claim according to the terms of your benefit plan.
  2. If medical records were not already provided, we will ask for them from the treating provider as part of our claim review.

We are looking back at emergency room visits in Kentucky since August 2015 to make certain we are using the best information to make the decision. (For self-funded employers, we are offering to do the review for them.)

It is important that we continue to address this trend because it is impacting the cost of health care for consumers, employers and the health care system as a whole. At Anthem, we believe that getting care in the most appropriate setting is an important part of making health care simpler, more affordable and more accessible.

As always, nothing is more important than your safety. If you are experiencing a health emergency, you should always call 911 or go to the ER.