In yet, another startling episode outlining our broken healthcare system that is wrought with fraud committed by billion-dollar corporations, a new policy that is currently being rolled by Anthem, one of the largest health insurance carriers in the world, is forcing policyholders to diagnose themselves before visiting the emergency room.
In a story published by Sarah Kliff of Vox, Brittany Cloyd, a 27-year old mother from Kentucky, visited the emergency room after suffering from high fever and extreme pain to the right side of her stomach after Cloyd’s mother, a former nurse, believed the symptoms to be appendicitis. After examing her thoroughly with a CT Scan and an ultrasound, doctors were able to diagnose her with ovarian cysts and were able to medicate her pain and ordered a follow-up with a gynecologist.
A few weeks later, Cloyd received a letter from Anthem, the largest member of the Blue Cross Blue Shield federation, stating that her emergency room visit had been denied for being an “inappropriate” emergency room visit, leaving her with a whopping $12,596 bill that she had to pay herself.
According to the letter Cloyd received from Anthem, “Emergency room services can be approved … when a health problem is recent and severe enough that it needs immediate care” such as “stroke, heart attack, and severe bleeding.”
In other words, ‘If you don’t appropriately diagnose yourself before going to the ER, you’re going to be stuck with the bill.’
In a statement released by Anthem regarding their controversial policy, they claim that “For non-emergency ailments, ERs are an expensive — in many instances 10 times higher in cost than urgent care — and time-consuming place to receive care. Treating these non-emergency ailments in ERs increases the cost of health care for consumers and the health care system as a whole.”
After two appeals and inquiries made by Congressmen and media outlets, Cloyd’s $12,000 ER bill was eventually covered by Anthem.
Our law firm has already covered in-depth on both how and why hospital bills are so expensive, however, the story here shows that these illegal price-gouging practices committed by major hospitals have now spread into the billion-dollar health insurance industry. So who is to blame for the current state of our healthcare system? The hospitals for raising healthcare at unreasonable and irregular rates or the health insurance carrier who is denying legitimate claims?
Truthfully, both share an equal portion of the blame because the healthcare system they have concocted together is driving more and more premium-paying Americans into financial ruin.
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