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Is One U.S. Insurance Company Requiring Patients to Self-Diagnose?

BATON ROUGE, Louisiana. The New York Times and Consumer Reports have been investigating cases where Anthem, an insurance company, has denied patient's ER claims, claiming that the patients went to the ER when their situation wasn't an emergency. In cases where the insurance company has denied claims, it has said that patients should have called the insurance company's 24/7 hotline or gone to an emergency clinic. According to Consumer Reports, Anthem isn't basing whether it denies claims on a person's initial symptoms but rather on the final diagnosis that the ER gives. 

This is problematic because the insurance company is essentially asking patients to diagnose themselves. Many serious conditions can mimic more minor ones. If patients forego urgent care, they can suffer serious injury or even death. Some worry that the insurer's policy will discourage patients from seeking the emergency medical care they need.

While many ER doctors do note that about 1/3 of ER visits are for non-urgent matters, this doesn't mean that insurers should be able to deny coverage to people because they misjudged heartburn for a heart attack. 

Reports indicate that Anthem has been denying claims only to pay them after appeal. For patients who may not know they have a right to appeal, they may be stuck with prohibitive and large ER bills. Many people are not aware that they have the right to have denials reviewed by independent insurance regulators.

Doctors and trade groups have sued Anthem for its actions, according to the New York Times.

The insurance company's actions can lead to a range of problems for patients. For example, a doctor on the phone may not have the same ability to diagnose as a doctor in the ER. What rights do patients have when they call an insurance company's 24/7 hotline and get a wrong, and potentially life-threatening diagnosis? 

At the end of the day, the only way health insurance companies will be held accountable is when people fight back. If a doctor on the phone misdiagnosed you or your loved one, leading to worsening conditions, you may have rights. If your insurance company denies your ER claims, you have a right to appeal the claim and even the right to lodge a complaint with your state's insurance regulator.

The Bowling Law Firm are personal injury lawyers in Baton Rouge, Louisiana who are closely watching this situation unfold. At the end of the day, if you believe you have a life-threatening condition, you may want to make a visit to the ER. Unexplained dizziness, trouble breathing, chest pains, and broken bones are all conditions that warrant a visit to the ER. If you believe that a doctor or insurance company's actions resulted in your injury or illness, consider reaching out to the Bowling Law Firm today. You may be entitled to receive a recovery for your losses. 

The Bowling Law Firm, A Professional Law Corporation 

1615 Poydras Street, Suite 1050 

New Orleans, Louisiana, 70112 

Phone: 504-613-4561 

Toll Free: 877-757-3539

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