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Julie Kliger

Senior Managing Director at FTI Consulting, Healthcare Solutions Enterprise Technology and Digital Transformation Co-Leader

127377 followers 500+ connections
Question:Heart Attack or Indigestion? Aortic Dissection or Stomach Flu? Ruptured Spinal Disc or Sprained Muscle? Answer: How the heck should I know?...That’s what the ER is for! But...Not so, according to Anthem (and probably other) health insurers. Apparently there are “New Rules” for what gets covered and what you get billed for. New Rules include: Needing to know what’s wrong with you before you get to the ER; Getting billed for the whole Cost of Care if your problem is not serious. I fully realize that many ER visits are for basic health care needs (in part because our primary care system is broken and many people do not have regular doctors) BUT, this practice by insurers of using ‘hindsight diagnosis’ is unethical and well, cruel. Selected Excerpt: “Anthem denied thousands of claims last year under its “avoidable E.R. program...”. The program, which Anthem has been rolling out in a handful of states in recent years, reviews claims based on the final diagnosis of patients.” …see more

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