Monday, July 25, 2005

UPDATE: Out of Network Emergency Care...

As you may recall, a few weeks ago I wrote about a carrier’s decision to penalize its insureds who received emergency care from non-participating providers.
My understanding was that this was a no-no, and I began a correspondence with the Ohio Department of Insurance about it.
The carrier in question is Anthem Blue Cross/Blue Shield, and I’ve received this answer from the DOI, which says that Anthem’s position is “kosher:”
(A)n indemnity insurer licensed to do business under Title 39 of the Ohio Revised Code would not be prohibited under applicable Ohio law from implementing the practice described in Anthem's notification.
In short, plans such as this are not subject to the limitation on Out of Network (OON) penalties.
Now comes word that Anthem won’t implement this change until the first of next year. They can’t resist the cheap shot, though: “(C)urrently there are only two hospitals that offer emergency services in Ohio, Kentucky and Indiana that are not contracted with Anthem in any network. Those are (the) Premier Health Partners hospitals.” Again, punishing your policyholders for something that is absolutely out of their control.
It may be legal, but it just ain’t right.
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