Post by Kevin Herrington, MBA FACHE, Altus Emergency Centers

Last year, Anthem started notifying its policyholders in certain parts of the country, that if their ER visits end with a diagnosis for something that isn’t considered an emergency, they would be responsible for 100 percent of the cost of their visit (and this determination would be made not by the doctor, but by the insurance company—after the fact).

The problem with this policy is that most of us don’t have enough medical knowledge or training to self-diagnose before going to the ER. According to The American College of Emergency Physicians(ACEP), there is nearly a 90-percent overlap in symptoms between emergencies and non-emergencies, according to a study in the Journal of the American Medical Association (2013). These symptom overlaps make it extremely difficult for any of us to clearly determine the difference between abdominal pain that is life-threatening and abdominal pain that is not.

The fear factor that Anthem is creating with their denial policy means more people will increasingly choose to wait and see if their symptoms improve before seeking immediate emergency medical attention, a decision that could lead to serious health challenges, lifelong disabilities, or even death.

Kevin Herrington began as an Administrator for Altus in early 2007, and has successfully managed several facilities since construction. With 20 years of experience in healthcare, Kevin currently oversees operations, as well as the development and direction of all future projects. Kevin currently holds the status of Fellow with the American College of Healthcare Executives, and is a member of the American Society of Clinical Pathologists.