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August 2018Volume 36, Issue 8, Pages 1511–1512
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Appropriations for “appropriate” visits: Payment denials for emergency department care

Peter B. Smulowitz
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Peter B. Smulowitz
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Affiliations

  • Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
, MD, MPH
,
Ari B. Friedman
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Ari B. Friedman
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Affiliations

  • Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

Correspondence

  • Corresponding author at: 1 Deaconess Road, Boston, MA 02445, USA.
, MD, PhD'Correspondence information about the author MD, PhD Ari B. Friedman
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Ari B. Friedman
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Affiliations

  • Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

Correspondence

  • Corresponding author at: 1 Deaconess Road, Boston, MA 02445, USA.
,
Jesse M. Pines
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Jesse M. Pines
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Affiliations

  • Departments of Emergency Medicine and Health Policy and Management, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
, MD, MBA, MSCE
Appropriations for “appropriate” visits: Payment denials for emergency department care
DOI: https://doi.org/10.1016/j.ajem.2017.12.061
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Recently, several large insurers including Anthem in New York, Kentucky, and Missouri as well as Blue Cross Blue Shield (BCBS) of Georgia announced policies to deny payment for visits to the Emergency Department (ED) retrospectively deemed “inappropriate.” These policies rest on the assumption that patients are misusing EDs for low-severity conditions that are more appropriately treated in settings other than the ED that are less expensive to insurers. While the particulars of these policies are still emerging–indeed, at least one prominent insurer was unable to provide any details of their program–the concept of dissuading ED use is not new.

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August 2018Volume 36, Issue 8, Pages 1511–1512