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While such policies seem like a prudent way to deal with consumers who run to the ER with symptoms of a common cold, the reality is that it’s hard to draw a clear line in the sand.

Insurers have come under scrutiny in the past for policies rejecting claims for visits to the emergency room that they deem unnecessary. The latest to find itself in hot water? Aetna, which has been fined $500,000 by California’s Department of Managed Health Care after a sampling of claims from 2019 found it had denied 93% that it deemed unnecessary.

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Emily Payne

Emily Payne is managing editor at BenefitsPRO. A Wisconsin native, she spent the past eight years writing and editing for various athletic and fitness publications. She holds an English degree and Business certificate from the University of Wisconsin.

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