|Cloyd with her daughter|
(Vox photo by Luke Sharrett)
That was the case with Brittany Cloyd of Frankfort, Ky., after she went to the ER for severe abdominal pain that she thought could be appendicitis. She was diagnosed with ovarian cysts, and was prescribed pain medication and told to make a follow-up appointment with her gynecologist. Anthem refused to pay the $12,596 bill because it deemed pelvic pain not severe enough for immediate care. In the refusal letter, Anthem listed "stroke, heart attack, and severe bleeding" as examples of acceptable medical conditions for an ER visit. Anthem denied Cloyd's bill twice, but approved it after Kliff asked the company for an interview.
Anthem argues that it's trying to cut health-care costs and keep people from using the ER inappropriately. But critics say the policy effectively forces patients to practice medicine and diagnose themselves. "It’s not fair to expect the patient [to come] in knowing their diagnosis. If they did, they wouldn’t come in and wait for ours," said Renee Hsia, a practicing physician and professor of health policy studies at the University of California San Francisco.