Ethical Issues In Healthcare

Unless the recent policy change of Anthem, an insurance giant in the US, is challenged in the court, more emergencies may be denied payment and the bill left in the hand of patients. The policy, although it will apply to six states, will be rolled out in all 14 states where Anthem has Blue Cross Blue Shield affiliates.

The American College of Emergency Physicians and other groups asked Anthem to reconsider the policy. Dr. William Thorwarth, the CEO of the American College of Radiology, said that if doctors would not challenge the rule, other insurers will follow Anthem’s example, Naples News reported.

Policy in unlawful

In a video released in January, the ACEP called Anthem’s policy as unlawful. In 2017, Anthem, based in Indianapolis, started

But the second policy has exceptions.

Lawsuits by Piedmont

Because of the new Anthem policies, the Piedmont Hospital group, based in Atlanta, filed a lawsuit against Anthem and Blue Cross Blue Shield of Georgia. It claimed that the policies were a breach of contract and harmful because it intentionally and maliciously sought to deteriorate health care coverage for the members and significantly reduce reimbursement for the providers.

An Anthem medical director uses a prudent layperson standard to deny an emergency room claim. The standard requires insurance coverage based on symptoms and not a final diagnosis. Anthem wants the patients in the affected states to instead go to urgent care centers rather than emergency rooms for treatment.

The 11 national medical associations wrote a letter to the insurer in January to tell Anthem that the new policy could violate the prudent layperson standard. The groups pointed out that in essence, Anthem is expecting the patient to act as a medical professional. They asked the insurance giant to rescind the harmful

The exceptions are if the doctor tells a patient to go to the ER or when the ambulance brings the patient to the emergency room. But there must be a document justification for the ER visit.

Aetna versus CNN

Meanwhile, another insurance giant, Aetna, accused CNN of taking a deposition out of context. Aetna said CNN did it to create media and courtroom leverage, Fox News reported. According to CNN, Dave Jones, the insurance commissioner of California, was outraged when he was shown a transcript of the testimony which he felt proved that Dr. Jay Ken Iinuma, an ex-medical director of Aetna, never looked at patient records when he decided when to approve or deny care.

After Iinuma admitted under oath that he never looked at the record of the patient when deciding to approve or deny care, Jones launched an investigation of Aetna. He said he was following the training of Aetna. CNN reported that a lawsuit was filed by a college student against Aetna after he suffered from a rare immune disorder which Iinuma knew nothing about and did not look at the student’s medical