Recently, several large insurers including Anthem in New York, Kentucky, and Missouri
as well as Blue Cross Blue Shield (BCBS) of Georgia announced policies to deny payment
for visits to the Emergency Department (ED) retrospectively deemed “inappropriate.”
These policies rest on the assumption that patients are misusing EDs for low-severity
conditions that are more appropriately treated in settings other than the ED that
are less expensive to insurers. While the particulars of these policies are still
emerging–indeed, at least one prominent insurer was unable to provide any details
of their program–the concept of dissuading ED use is not new. If history is a guide,
these policies are unlikely to succeed. Previous attempts, most notably in the heyday
of Health Maintenance Organization (HMO) in the 1990s, were stymied by patient harm
from refusal of HMOs to approve or pay for emergency care [
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Article Info
Publication History
Published online: December 27, 2017
Accepted:
December 27,
2017
Received:
December 26,
2017
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
