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  • As an Insurer Resists Paying for 'Avoidable' ER Visits, Patients and Doctors Push Back New York Times by Reed Abelson, Margot Sanger-Katz & Julie Creswell — To rein in emergency medicine costs, Anthem is reviving an old, contentious tactic: pushing back on patients who visit the emergency room (ER) for ailments deemed minor. Anthem denied thousands of claims last year under its "avoidable ER program," according to a sample of ER bills analyzed by the American College of Emergency Physicians. The program, which Anthem has been rolling out in a handful of states in recent years, reviews claims based on the final diagnosis of patients. Emergency room physicians say that, last year, the company did not routinely request medical records for denied patients, and therefore could not review the symptoms that brought them to the emergency room. Anthem says it is now reviewing such records before issuing denials. "The costs of treating non-emergency ailments in the ER has an impact on the cost of health care for consumers, employers and the health care system as a whole," Jill Becher, a company spokeswoman, said in an email. But doctors and consumer advocates argue that the policy forces patients to diagnose their own illness, and may discourage people with serious problems from seeking care.

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