Agencies Urged to Review Potential Violations of ED Coverage Standard

Sens. Ben Cardin (D-MD) and Claire McCaskill (D-MO) this week asked Health and Human Secretary Alex Azar and Labor Secretary Alexander Acosta to review whether Anthem or any other health plan’s emergency department coverage policies violate the prudent layperson standard. “As you know, patients must be able to seek emergency care without fearing their health insurance company will require prior authorization or deny their claims,” the senators wrote. “Patients should never be in a position of correctly diagnosing their specific emergency medical condition before seeking professional medical help.” In a letter to Anthem this week, AHA and other hospital groups expressed “serious concerns that Anthem's coverage policies for outpatient imaging and emergency care services are detrimental to patients, diminishing access to care and driving care location based on the lowest cost provider.”