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Some ER Visits Won't Be Covered By New Blue Cross Blue Shield Policy

Blue Cross Blue Shield Building Sign
Tony Webster
Wikimedia Commons
Blue Cross Blue Shield Building Sign

Health insurance provider Anthem Blue Cross Blue Shield will stop covering certain emergency room visits starting in 2018. The American College of Emergency Physicians is against the change because it could put people with life-threatening illness at risk.

Beginning January 1, Ohio patients who have been treated in emergency departments may be responsible for all costs if their eventual diagnosis isn't on a list of preapproved diagnoses, as decided by Anthem Blue Cross Blue Shield. 

The Ohio American College of Emergency Physicians chapter co-chair Brad Raetzke says this policy violates the prudent layperson standard, which encourages patients to seek out care when they think they may need it. 

“Our main concern is this policy is putting the patient on the hook to determine whether they have a life-threatening condition or not,” Raetzke says. “This should really be done between the patient and the physician.”

According to a press release from the American College of Emergency Physicians, "rash" is not one of the covered diagnoses, but a number of serious diseases such as Lyme disease can first show up as a rash.

Blue Cross Blue Shield has said it is implementing the policy so people don't use the emergency room as their primary healthcare.

Adora Namigadde was a reporter for 89.7 NPR News. She joined WOSU News in February 2017. A Michigan native, she graduated from Wayne State University with a B.A. in Broadcast Journalism and a minor in French.