Ohio House bill would prohibit Anthem, other insurers from denying some ER claims

Written on Mar 08, 2018

A Cincinnati Democrat has introduced a bill in the Ohio General Assembly that would prohibit insurance companies from denying paying for some of their policyholders' emergency room claims.

House Bill 536 attempts to halt a new rule by Anthem Blue Cross Blue Shield that went into effect at the beginning of the year, in which the company reviews all ER claims and denies those it determines were not an emergency.

The insurer is hoping to decrease expensive ER visits, which can cost 10 times as much as trips to urgent care centers.

Rep. Alicia Reece's bill would prohibit the new rule for individual and employer policies as well as policies Medicaid recipients get through managed care.

Currently, Anthem's rule does not apply to Medicaid managed care recipients.

Failure to comply would be an unfair or deceptive insurance business practice in HB 536, making the policy not compliant under Ohio insurance law.

Reece is working with the Ohio Department of Insurance on any additional penalties that could be imposed on companies for what the bill calls "selective emergency services insurance coverage."

Reece hopes the bill will nip Anthem's new rule in the bud.

The bill faces an uphill battle: All the sponsors are Democrats, but the legislature has a GOP supermajority.

Reece and other Democrats wrote a letter to Gov. Kasich. The letter is under review by the Kasich administration.

Anthem insures 3.4 million Ohioans and has never said how many people are affected by the new ER rule.

In addition to Medicaid managed care, some policyholders work for companies that hire Anthem to provide health insurance. Others work for self-insured companies that hire Anthem to verify and pay claims.

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