Doctors Sue Anthem Over Company Policy On Not Paying For Some Emergency Care Costs
The insurer instituted the policy with the goal of cutting down unnecessary emergency room visits, which drive up health care costs. But the doctors say Anthem violated legal requirements that insurers cover care in a situation where a “prudent layperson” would believe he or she was experiencing an emergency.
Bloomberg:
Anthem Sued By Doctors In Dispute Over Emergency-Room Coverage
The health insurer Anthem Inc. was sued by doctors in Georgia for declining to pay for some emergency-room care, escalating a long-running battle over how far insurance plans can go to push patients to seek lower-cost treatment. The American College of Emergency Physicians and the Medical Association of Georgia filed suit on Tuesday in U.S. District Court in Atlanta against Anthem’s Blue Cross and Blue Shield of Georgia unit over the denied payments. The doctors asked the court to require Anthem to halt its policy and cover the claims. (Tracer, 7/17)
Modern Healthcare:
Emergency Docs, Georgia Medical Association Sue Anthem Over ED Policy
In February, Atlanta-based Piedmont Hospital and five sister hospitals filed lawsuits claiming Anthem's policy of denying coverage for non-emergency ED visits after the fact violates Georgia law. But while Anthem tweaked the ED program in February in response to outrage from state legislators and the public, it has refused to rescind it. So ACEP—after months of back-and-forth with Anthem detailed in the lawsuit—is jumping into the mix. "This is a first step in the process and depending on how things play out, we would entertain filing in other states where Anthem is (implementing) the policy," said Laura Wooster, associate executive director for public affairs in ACEP's Washington office. (Livingston, 7/17)
Georgia Health News:
Physicians Groups Sue Over Blue Cross Denial Of Some ER Claims
Two physicians organizations filed a lawsuit Tuesday against Blue Cross and Blue Shield of Georgia and its parent company over the insurer’s emergency room payment policy, calling it “dangerous.’’ The parent company, Indianapolis-based Anthem, has pursued a new policy over the past year in Georgia and five other states, reviewing customers’ ER visits and limiting or denying payment for those it deems not to have been true emergencies. (Miller, 7/17)
In other health industry news —
Bloomberg:
Cyberattacks On Health-Care Providers Are Up In Recent Months
Health-care providers and government agencies across the U.S. have seen an increase in cybersecurity breaches in recent months, exposing sensitive data from hundreds of thousands of people as the sector scrambles to find adequate defense mechanisms. “These threats are real,” Oscar Alleyne, senior adviser at the National Association of County and City Health Officials, said Tuesday during a panel in Washington. The breaches include malware attacks, computer thefts, unauthorized network access and other security breaches, according to a government database that tracks attacks in the health-care sector. (Kasumov, 7/17)
Nashville Tennessean:
Envision Is Underpaying Shareholders In $5.6B Sale To KKR, Lawsuit Says
A new federal class-action lawsuit is claiming that shareholders of a massive Nashville-based health care company are being underpaid in the $5.6 billion sale to a private equity firm. Envision Healthcare Corporation, which runs hundreds of surgery centers in 35 states, announced last month it would be sold to KKR, an equity firm that has been on a spree of health care company acquisitions. (Kelman, 7/17)
