If a patient does not have liability for a particular expense, the insurer is similarly absolved of responsibility. The June 14 issue of RACmonitor focused in part on Anthem’s policy regarding coverage of ED services. The relevant article suggested that insured patients should not face responsibility for emergency room bills.…
Anthem’s ED policy prompted a Missouri law that defines a medical emergency. The Upshot column in the New York Times on May 19 focused on Anthem’s experiment with denying emergency room visits, arguing that patients should have known that ED care was unnecessary.    One of the anecdotes in the…
An analysis of your peer-to-peer process might lead to your abandoning the program. The peer-to-peer (P2P) process is a particularly abhorrent chore for physicians. These phone conversations are generally offered by commercial and managed insurance plans when their clinical case manager or medical director does not feel that inpatient status…