Bring out the emergency-room paddles, Anthem.

That $47.5 billion takeover offer for Cigna doesn’t make the grade, the board said, rejecting the “highly conditional, non-binding proposal” for its smaller rival as inadequate.

So, maybe, Anthem will be jolted into sweetening its offer even further.

The back and froth in the managed-care world stepped up when sector giant Aetna recently made a takeover proposal for Humana, which boasts a market value of $30 billion.

Anthem made its cash-and-stock offer public on Saturday in an effort to put pressure on Cigna through its shareholders, the WSJ.com report said, citing a source.

A fifth company, UnitedHealth Group, has made a takeover approach to Aetna. Analysts reckon that regulators will allow only one or two such combinations.

Merger fever is tied to a need for the Big Five to boost efficiency in order to better respond to changes brought on by the Affordable Care Act and other developments.