Bill would prohibit Anthem, other insurers from denying some ER claims

As promised, a Cincinnati Democrat introduced a bill in the General Assembly that would prohibit insurance companies from denying paying for some of their policyholders’ emergency room claims.

House Bill 536 attempts to halt a new rule by Anthem Blue Cross Blue Shield that went into effect at the beginning of the year, in which the company reviews all ER claims and denies those it determines were not an emergency, according to Monday morning’s Capitol Letter,’s daily Statehouse newsletter.

The insurer is hoping to decrease expensive ER visits, which can cost 10 times as much as trips to urgent care centers.

Rep Alicia Reece’s bill would prohibit the new rule for individual and employer policies as well as policies Medicaid recipients get through managed care.

Currently, Anthem’s rule does not apply to Medicaid managed care recipients.

Failure to comply would be an unfair or deceptive insurance business practice in HB 536, making the policy not compliant under Ohio insurance law.

Reece said she’s working with the Ohio Department of Insurance on any additional penalties that could be imposed on companies for what the bill calls “selective emergency services insurance coverage.”

Reece hopes the bill will nip Anthem’s new rule in the bud.

“This is a slippery slope,” she said. “if we allow this to happen, it becomes the standard for how all insurance companies operate.” sent Anthem and Ohio Association of Health Plans representatives the bill, but neither provided an opinion on it.

The bill faces an uphill battle: All the sponsors are Democrats, but the legislature has a GOP supermajority.

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