Ohio lawmakers consider banning tax breaks, state contracts from Anthem over ED policy: 4 things to know

Three Ohio legislators want to draft a bill barring insurers like Anthem who cover emergency department visits on a discretionary basis from state contracts and tax incentives, The Columbus Dispatch reports.

Under Anthem's ED policy, which took effect in Ohio at the beginning of this year, Anthem will review diagnoses after members' emergency room visits. If the condition is determined to be nonemergent, Anthem may not cover the ED visit.

Here are four things to know about Ohio lawmaker's proposals.

1. At a news conference Feb. 21, state Rep. Alicia Reece, D-Cincinnati, said her and other lawmakers are considering a bill to penalize insurers who impose ED policies akin to Anthem's. Ms. Reece, along with two other Democratic representatives, said a potential bill would deny tax breaks and contracts to manage insurance for state, county and city employees to insurers like Anthem.

2. The three lawmakers plan to ask for intervention from Ohio Gov. John Kasich, R, on Anthem's ED policy. They also will call on Ohio Attorney General Mike DeWine, R, to investigate the legality of Anthem's discretionary coverage.

3. Anthem spokesperson Jeff Blunt told The Columbus Dispatch, "Anthem's ER program aims to reduce the trend in recent years of inappropriate use of ERs for non-emergencies. For non-emergency health-care needs, ERs are often a time-consuming place to receive care and in many instances 10 times higher in cost than urgent care." He added Anthem members — with 3.5 million located in Ohio — should always call 911 or visit an ER if they have an emergency.

4. Anthem rolled out its ER policy in Ohio, Indiana, New Hampshire, Missouri, Georgia and Kentucky. The Columbus Disptach reports the policy has several exceptions, including:

  • if a healthcare professional directs a patient to the ED
  • if the patient is younger than 15 years old
  • if the patient lives 15-plus miles from an urgent care facility
  • if the patient is traveling
  • if the ED visit happens on a major holiday or between Saturday evening and Monday morning
  • if visits are billed as urgent care or are associated with an inpatient or outpatient visit
  • if the patient receives surgery, IV fluids or IV medications, or an MRI or CT scan

More articles on payer issues:
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Viewpoint: Medicare Advantage claims data should be made public
Anthem: It's not medically necessary for anesthesiologists to assist most cataract surgeries

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