Dr. Thompson's Blog

Concern about Anthem Health Insurance not Paying ER Bills

There was a Letter to the Editor in the 5/28/18  New York Times that greatly concerns me.  it was written by an M.D. in Illinois about about the insurance company, Anthem, and their "tactic of refusing to pay emergency room bills in certain cases." I had not heard  of this and certainly want to find out if more health insurance companies are doing it.  The doctor noted that Anthem had profits of $3.8 billion in 2017. Their stockholders must be very happy, but don't the CEO or the Board of Directors have any worries that someone could die or lose their home because of this policy? I realize the company is trying to keep non-emergencies out of the ER, but if doctors won't take Medicaid or Medicare or a family does not have Anthem health insurance what are they to do if there is a medical problem? The glory days of medicine are certainly over.

I thought it was illegal for an ER to refuse to see a patient.  Perhaps they see them but then just find a way to bill them? As Trump and the Republicans try to chisel away at Obamacare, more and more patients are going to  have to use an ER for medical care. Mrs. Trump was able to  stay in  the hospital at no charge for as long as she  wanted without any charge when that family is worth billions. Something is certainly wrong.

I realize there are certainly problems with universal health care, such as they  have in England and other civilized countries. However, this country has been very innovative in other areas, so why can't we find a way to offer medical care at affordable rates to everyone? No one should become homeless or die because they were refused good medical care or did not  have the money to pay for it.

Hospital Care for the Rich Versus Care for the Poor and Middle Class

I asked a physician who is familiar with the procedure Melania Trump had how a patient without her status would been treated. If the patient was able to get approval for the procedure, he said then he or she would be discharged the same day or the next day. A week's stay would not be possible. How fortunate to have the very best medical care at no cost to yourself and no restrictions on the length of a hospital stay. 

Something is very wrong that Congress and people in the administration can get wonderful medical care and the poor and middle class cannot. Trump and the Congress are slowly  working to get rid of as much of Obamacare as they can. Medicine has changed so much that patients  have to fight not only insurance companies, but also physicians to get the care they need and deserve. Every patient needs a family member or friend to be an advocate if they are sick. 

I spend considerable time helping patients find good medical care and  giving them the questions they need to ask. I always suggest they keep a written record of every contact they  have with insurance companies, Medicare and physicians or their assistants. Now that nurse practitioners are taking over a lot of medical care, patients must be particularly assertive to be sure the care they receive is adequate. It was wonderful to be in private practice when you could keep a patient in the hospital as long as was needed and not get prior approval from an insurance company. I had one mother who asked to stay a few extra days after  her baby was born because she could not tolerate her visiting mother-in-law.  Her mental health was very much at risk and to me it was important that she not have to do battle with the woman. I made a few house calls when the mother was home and the mother-in-law was gone. I was glad to see that everything was going smoothly. That could not happen today.