Throughout these efforts, ACEP staff and leadership have met with key Anthem representatives on five separate occasions to voice their concerns and offer constructive alternatives to the policy. Chapters in affected states have met with the insurer, but there has been little headway.
Most recently, ACEP President Paul Kivela, MD, MBA, FACEP, sent an email to contacts at more than 100 emergency department groups asking them to review any Anthem denials they might have in the six affected states and, where possible, provide ACEP with aggregated statistics illustrating them. Having data to cite on the impact and breadth of the Anthem policy is critical to supporting continued advocacy on the issue with state and federal policymakers and making a case for them to take enforcement action. ACEP is also engaged in coalition-building activities with other specialties (eg, the American College of Radiology, the American Academy of Dermatology, and the American College of Surgeons) affected by the damaging Anthem policies in order to maximize resources and bring additional attention to the issue. In addition, ACEP is engaged with consumer groups to ensure the patient voice is heard.
Shortly before press time, Anthem announced it was changing the policy to add additional “always pay” exceptions, including when the emergency department visit was associated with an outpatient or inpatient admission, or when the patient received any kind of surgery, IV medication, or an MRI or CT scan. Anthem also said it will now also request and review medical records before denying claims. While these changes signal the insurer is feeling significant public pressure as a result of a coordinated advocacy effort, ACEP put out a statement noting these changes aren’t nearly enough, and that Anthem must withdraw the policy altogether. Sen. McCaskill put out a similar statement and once again called on the insurer to provide the documents she had previously requested.