Anthem last week notified network providers in Missouri, Kentucky and Georgia about changes to its program to prevent “avoidable” emergency department visits. “Specifically, we have expanded our list of ‘always-approve’ exceptions,” the notice states. “We will take that new list of exceptions and look back at claims that were previously denied. If one of those conditions was present, we will change the decision and pay the claim according to the terms of the benefit plan.” While the program also was implemented in Ohio and Indiana Jan. 1, reviews in these states have already occurred, the notice states. Anthem has not released the complete list of exceptions; however, news reports indicate that they include instances where an individual is directed to an ED by clinical personnel.

Related News Articles

Headline
More than two-thirds of air ambulance transports for patients with private insurance were out-of-network in 2017, putting patients at financial risk for the…
Headline
The Food and Drug Administration today alerted health care providers to safety risks associated with cesium chloride, a mineral salt sometimes taken by cancer…
Insights and Analysis
Hospitals and health systems across the country are finding myriad ways to provide affordable, patient-centered care to consumers. A panel of leaders recently…
Headline
According to a randomized trial reported today in the Journal of the American Medical Association, opioids are no better than non-opioid medications at…