EDITORIAL: Bad policy on health care

March 22--Health insurers already have a huge say in our lives.

People routinely must make decisions about certain procedures or medications not covered by their insurance company. Do they pay out of pocket or do they try to get along without something a doctor has told them could improve their life? Too often we fear the decision has to be to simply forego -- or face medical bankruptcy.

If that's not bad enough, now at least one national insurer -- Anthem -- is saddling its customers with the entirety of an emergency room bill if it turns out the person wasn't having a "real emergency."

So if it feels like an elephant is sitting on your chest, you think you are having a heart attack but it turns out to be heartburn, too bad for you. Instead of a co-pay of a few hundred dollars, you will pay the entire bill, which, depending on the procedure and the hospital, could be several thousand dollars. Because, according to Anthem policy, you were not having an emergency.

In a Globe story on Wednesday, March 21, reporter Koby Levin reported on a request from Sen. Claire McCaskill, D-Mo. to the U.S. Department of Health and Human Services to look into the potential violations of the "prudent layperson standard."

If there is a violation, Anthem has to "cease and desist," she told The Globe.

Anthem has denied any violation of the federal law but stands by its belief that emergency rooms are an expensive place to receive routine care. We agree with that. Often, uninsured patients use an emergency room as a primary care physician, knowing they won't be turned away.

But we're talking now about those who are paying for insurance and could face bearing thousands of dollars in costs if they don't correctly diagnose their emergency in advance.

Anthem has introduced this policy in six states, including Missouri. The others are Georgia, Kentucky, New Hampshire, Indiana and Ohio.

There is legislation introduced in the Missouri Senate by Sen. Paul Wieland, R-Imperial, that could counteract the Anthem policy.

Whether Anthem's policy breaks federal law or is simply an insurer placing too much of a medical burden on the patient, Anthem -- and other insurers who may be considering this protocol -- needs to reconsider.

Lives will depend on it. One of those lives could be yours. Write your legislator today.

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