EDITORIAL: Anthem denies coverage, then reverses itself after bad publicity. There’s a lesson here.

St. Louis Post-Dispatch (MO)

July 22--The health insurance company Anthem Blue Cross Blue Shield knows fully well the crucial role it plays in the lives of health care-strapped Missourians. The company, America's second-largest health insurer, appears to be exploring every possible option to milk its advantage and maximize profits on the backs of patients.

The only thing that appears to put the brakes on Anthem's exploitative practices is the bad publicity it receives when those practices are exposed, such as when customers report being denied coverage for emergency room visits clearly necessary for the patient's survival.

An inquiry led by Sen. Claire McCaskill, D-Mo., determined that the numbers on denied coverage were far more than a handful. In the last half of 2017, Anthem denied the emergency-room claims of 12,200 patients in Missouri, Kentucky and Georgia, McCaskill's inquiry found. During the final quarter of 2017, Anthem's profits jumped 234 percent, to $1.2 billion, over the same period in 2016.

To be fair, Anthem and other insurance companies face a difficult burden sifting essential emergency room visits from those that easily could be avoided. Not every cut finger or flu symptom requires an emergency room visit.

But Anthem knows it went way overboard in its pursuit of profits -- so much so that the company reversed itself on 62 percent of those 12,200 coverage denials. The reversals no doubt came as a big relief for the patients, but imagine the enormous hassle and anxiety they endured during the company's claims-appeal process.

Earlier this year, criticism of Anthem swirled after details emerged about a boy, Ben Millheim, who suffered a fractured skull on a camping trip in 2016 and was airlifted 83 miles to a St. Louis hospital. Anthem denied full coverage because the helicopter company was deemed "out of network." Ben's parents were socked with a $32,000 bill.

Missouri, Kentucky and Georgia were the first three states where Anthem rolled out more stringent policies in a bid to make patients think twice about whether their emergency was really an emergency. Sometimes, as in Ben Millheim's case, desperate parents don't have time to question whether a service is in-network or out. They just want to save their child's life.

The denials by Anthem appear to have been "an example of an insurance company looking for ways to save a buck at the expense of their patients, only to then reverse course to try and save face once folks noticed and called them out," McCaskill said in a statement.

We don't want to deny any company its right to make a fair profit, but there comes a point when exploitation needs to be called by its name. And since Anthem seems to respond when immersed in negative publicity, it remains important for patients to speak out when they feel they've been unfairly treated.

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