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Effective January 1, 2018, Anthem may hold subscribers responsible for charges if they use the ER for non-emergency care

 

Effective January 1, 2018, non- emergency services will not be covered when treated in an emergency room (ER), if more appropriate settings are available. The claim will be reviewed by one of Anthem's medical directors using the prudent layperson standard and potentially denied. If a member's claim for emergency services is denied, it will be denied as member liability.

This means that employees who choose to receive non-emergency care in the ER will be responsible for the charges.

 

 
Daniel Elbaz