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Anthem Is Changing the ER Coverage Game. What Does This Mean For Your Practice?

Anthem, America’s second largest health insurance provider, has changed its emergency room policy. And while those words often aren’t so good to hear, you may be surprised by the effect they will have on your urgent care business. Those with an Anthem plan won’t have their visits to the ER covered, now, if they visit for a non-emergency reason. This is to keep from congesting the ER waiting room, and to keep the company from having to cover the expenses of such an expensive visit. This means more business for your urgent care clinic!

 

Be anticipating this change as it is being implemented gradually into the states that have Anthem coverage. This policy, though it’s starting off a bit rocky, will help urgent care clinics in the long run. To take advantage of this, it may be beneficial to extend your clinic’s hours to take in the patients that would normally be going to an ER for visits. If the business model supports it, you could consider taking your clinic to a 24-hour system so it is open for the same amount of time as an ER. This availability is further incentive for patients to come to your urgent care clinic over an ER should they injure themselves at a time where their primary care doctor is not open. By adding these additional hours your community is greatly benefited. It’s also good for your employees through adding more positions and having more flexible hours.  Urgent care visits are cheaper for both patients and insurance companies compared to ER visits, so you can focus on this aspect, as well, to draw in clients to your clinic.  

 

Many medical professionals are afraid of the effect this policy may have on patients. Will people be too afraid to visit an ER now, even if it is an emergency? Most people who go to the ER go because they are experiencing symptoms they think are something serious. They may go with the impression it is an emergency, but if that turns out to not be the case, then they may have to foot the entire bill now. Each case will be reviewed by Anthem before coverage is denied to, in theory, keep that from happening.

 

So, what does this mean to an urgent care business? Some of the problems urgent care clinics run into come from the simple fact that not everyone knows what urgent care clinics treat. They may think that the only place they can go to for a small burn is the ER, while they can easily go to an urgent care clinic instead. Try to make it more apparent what the function of urgent care is in your community so that they know that visiting you is a more viable option than dropping by an ER in many cases.

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