Here are five things to know about the lawsuit:
1. The medical groups filed their suit July 17 in Atlanta’s U.S. District Court against Anthem subsidiary Blue Cross Blue Shield of Georgia. The physicians requested the court require Anthem to cover any denied ED claims and to stop its policy.
2. Anthem implemented a new ER policy in Georgia in 2017. Under the policy, Anthem reviews diagnoses after members’ emergency room visits. If the condition is determined to be nonemergent, Anthem may not cover the ER visit. The policy is effective in Kentucky, Missouri, Ohio, New Hampshire and Indiana, according to Bloomberg‘s reading of the lawsuit.
3. ACEP represents more than 38,000 emergency physicians, and Georgia’s medical association has more than 7,800 physicians. In their filing, the physicians claimed, “Providers and patients alike are operating in fear of denial of payment by defendants when patients seek emergency department care.”
4. Atlanta-based Piedmont Hospital and five sister facilities sued Blue Cross Blue Shield of Georgia and Anthem in February over the policy.
5. Anthem has argued its policy aims to lower the high costs associated with members using the ED for nonemergent care. Anthem did not immediately respond to Bloomberg‘s request for comment on the lawsuit.
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