Anthem May no Longer Cover ER Patients at Martha Jefferson

Posted: Updated: May 15, 2013 07:53 PM EDT

Bad news could be on the horizon for anyone with Anthem Health Insurance. Patients may no longer be covered to see emergency room doctors at Martha Jefferson Hospital come the end of May.  

Martha Jefferson is holding out hope for a deal, but Anthem has told employers in writing they won't be working with them anymore. 

ER doctors at Martha Jefferson Hospital say their rate demands are reasonable. Anthem says that they're not, and if they don't reach an agreement by June 1, Anthem members could wind up paying the price. 

ER physicians in charge of Martha Jefferson and Anthem Blue Cross Blue Shield are in a deadlock.

Dr. Daniel Riccardi, an ER Physician, says their demanded rates are reasonable.

"The rates that we pay our doctors are below the average for the area, also what we're asking for from Anthem is in line with other insurers, and I am told that these are reasonable rate increases," said Riccardi.

But Anthem disagrees, and sent a notice to employers this week saying that as of June 1, the ER physicians at Martha Jefferson Hospital will no longer be covered "in network" - meaning more money out of patients' pockets.

Martha Jefferson COO Elliot Kuida says, regardless of an agreement, the ER physicians will remain and patients will be treated.

"We value the quality of physicians they bring to the table every day to take care of patients in our service area and we would like them to be able to attract and retain the best quality physicians that they can get to join the group and their compensation is part of that equation," said Kuida.    

Ricarrdi says that Anthem wasn't willing to come back with a counter offer but Anthem says the ER physician's group, Piedmont Emergency Consultants, told Anthem that it resigned.   

Martha Jefferson still encourages patients to go to the ER, but also urges patients to check with Anthem about what is covered.

Anthem member rates for ER physicians are uncertain until the deadline passes or an agreement is reached.

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