Emergency Physicians Sue Anthem in Georgia Over ED Policy

The American College of Emergency Physicians and Medical Association of Georgia this week filed a federal lawsuit seeking to compel Anthem's Blue Cross Blue Shield of Georgia to rescind a policy that retroactively denies coverage for emergency patients. According to the lawsuit, the policy violates the prudent layperson standard requiring insurance companies to cover the costs of emergency care based on a patient's symptoms, not their final diagnosis, and the 1964 Civil Rights Act because the denials disproportionally affect members of protected classes. "ACEP and MAG have tried multiple times to work with Anthem to express these concerns and urge them to reverse this policy, and they have refused,” the organizations said. “We felt we had no choice but to take action to protect our patients, and therefore are asking the federal court to force Anthem's BCBS of Georgia to abide by the law and fulfill their obligation to their policyholders." In March, AHA and other hospital groups also urged Anthem to abandon certain coverage policies for outpatient imaging and emergency care services that are detrimental to patients.