A policy against frivolous ER visits isn't necessarily a bad thing, it's that Anthem's system for determining what's frivolous was obviously flawed in this case

A policy against frivolous ER visits isn't necessarily a bad thing, it's that Anthem's system for determining what's frivolous was obviously flawed in this case. Side-splitting abdominal pain is a valid reason to go to the ER. But doesn't mean it's not sensible for Anthem to have a policy against footing the bill for ER visits for ingrown toenails -- an ER doc in Australia was recently telling me too much of his day is wasted seeing patients who aren't really sick, since Australia has a more generous healthcare system. But to me the bigger issue is a noninvasive visit to the ER cost 12K. It's easy to get riled up about a cabal of penny-pinching insurers cackling on their pile of gold coins while people suffer, but how does the hospital get off blame-free for that kind of gross overbilling? I'm no fan of the business practices of insurers. But insurance is not magic beans. The money doesn't just fall from the sky. If everyone on the plan goes for 12K ER visits the premiums are going to skyrocket for everyone else. Realistically they have to reign in costs somehow, it's just a matter of finding an ethical balance. Someone in the industry told me Anthem makes the most money of any insurer and its profit margin is 3%. Most of the profit is being captured elsewhere in the chain.