Awards & Associations

Anthem Blue Cross & Other Insurers Accused of ER Bill Coverage Denials

December 4, 2018

A Kentucky woman was rushed by her mother to the emergency room after she complained of pain “worse than childbirth” in her abdomen. She suspected her appendix had burst, but ER tests determined the cause was actually ovarian cysts. Her treatment amounted to painkillers and a second appointment scheduled with her own doctor.

The real shock hit a few weeks later when Anthem Blue Cross – the provider of her PPO health insurance plan – sent her a bill for nearly $13,000. Despite her insurance policy covering emergency room visits and the like, the company claimed, “Your condition does not meet the definition of emergency.” How she or anyone in her situation would be able to determine if the health crisis was an emergency or not in the moment of its occurrence was not elaborated on by the insurance company.

According to a recent study by the Doctor Patient Rights Project (DPRP), this story out of Kentucky is unfortunately not unique. More and more insurance companies are denying ER visit coverage for the same obscure reasoning. Anthem claims the shift in policy enforcement is an attempt to save policyholders money by ending apparently frivolous use of emergency rooms.

However, medical experts and politicians alike see the policy as just an attempt to boost the bottom line of insurance companies. Official letters and lawsuits alike have been sent and filed to halt the policy. Indeed, the policy seems to knowingly work oppositely of 1997 Prudent Layperson Standard for Medicare and Medicaid act language that states an emergency is any situation in which the average person with typical understanding of health or medicine would feel the need to seek immediate medical help due to acute, severe, or persistent symptoms.


If you get sent a massive bill from your insurance company after an emergency room visit, you need to know that your case does not begin and end there. You can appeal the bill, perhaps more than once, to challenge its validity. Our Tulsa personal injury attorneys of Saint & Associates, PLLP are here to help you understand your rights and options, and make the most of them to protect yourself from undue coverage denials. With our award-winning legal advocates by your side, you do not need to fear taking on big oppositions, like Anthem Blue Cross or another major insurance company. We will go toe-to-toe with them for you.

Call (918) 721-0998 or email our law office now.