Itchy eyes, in-grown toenails prompt change in ER visit coverage

CLEVELAND - It's a move some physicians say could leave people thinking twice about getting help during a critical medical moment.

A major insurance provider in the Buckeye State is trying to limit the ER to emergency visits only.

But, some physicians are calling out the plan that could leave their patients on the hook with hefty bills for wanting to quickly get their health checked.

The new year will bring new concerns when it comes to emergency room visits.

"We are the safety net of our population,” said Dr. Purva Grover, American College of Emergency Physicians.

ACEP is speaking out against changes in what will be covered when some patients stop at the ER.

"What this policy does is it discourages patients," said Grover.

Starting Jan. 1, Anthem Blue Cross Blue Shield of Ohio will decide if a patient's ER visit is warranted based on what they’re diagnosed with.

"Our patients are going to be in danger," said Grover.

The insurer tells News 5 it is in response to an increase in emergency room visits for things like in-grown toenails and itchy eyes from seasonal allergies.

Critics, like pediatric emergency physician Grover, fear the move to reduce the number of non-emergency ailments in the ER forces the patient to decide if what they're experiencing is life-threatening or not.

"It takes us seven years to get trained to make that decision,” said Grover. “Do we really think it's fair for a patient to decide that?"

Anthem says if a member thinks they are having an emergency they should always call 911 or go to the ER. Otherwise, it's an expensive and time-consuming place to receive care.

Dr. Grover tells News 5 she is worried the change will lead to patients getting sicker, or even dying, trying to decide what to do.

"They have no knowledge in that sense to say is this symptom worthy of an emergency department or not," said Grover.

Anthem tells News 5 it will cover non-emergency ER visits if a member was directed to the emergency room by another medical provider, if services were provided to a child under the age 14 or if the visit occurs between 8 p.m. Saturday and 8 a.m. Monday or on a major holiday.

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