“Anthem strives to make health care simpler, more affordable and more accessible, and one of the ways to help achieve that goal is to encourage consumers to receive care in the most appropriate setting. Anthem’s avoidable ER program aims to reduce the trend in recent years of inappropriate use of ERs for non-emergencies as the costs of treating non-emergency ailments in the ER has an impact on the cost of healthcare for consumers, employers and the health care system as a whole.



“If a consumer feels he or she has an emergency they should always call 911 or go to the ER. But for non-emergency health care needs, ERs are often a time-consuming place to receive care and in many instances 10 times higher in cost than urgent care.



“If a consumer chooses to receive care for non-emergency ailments at the ER when a more appropriate setting is available, an Anthem medical director will review the claim information and medical records using the prudent layperson standard. In the event a member’s claim is denied, they have the right to appeal.



“Anthem has made the decision to implement a number of enhancements to ensure that this program is implemented effectively across our participating markets. We are applying our new and enhanced procedures to previously denied claims and will overturn decisions where the new procedures would have resulted in an approval.”