BCBS of Texas to delay ER policy
Blue Cross Blue Shield of Texas will hold off on implementing its controversial approach to emergency room (ER) claims for 60 days after meeting with the state’s insurance commissioner.
The policy, as described by the Dallas Morning News, would affect patients in Blue Cross health maintenance organization (HMO) plans. If they seek care at an out-of-network emergency department, claims will be reviewed by a Blue Cross physician to decide whether the condition was serious enough to justify an ER visit. If not, the claim could be denied and the patient could be on hook for the entire bill.
The change doesn’t go quite as far as Anthem’s ER restrictions, which says claims can be denied on any ER visit it determines to be unnecessary based on final diagnosis rather than symptoms present at the time of the visit. Consumer groups and physician associations have opposed the policy, saying patients could be put their lives in danger by putting off needed emergency care for fear of receiving a big hospital bill—similar to the fear expressed by Anthem members.
"We expect to see changes that explicitly acknowledge Texas' legal protections for patients seeking emergency care," Douglas Curran, MD, president of the Texas Medical Association, told the Dallas Morning News. "We do not believe patients should be expected to self-diagnose to determine whether their symptoms are serious enough to warrant an emergency department visit.”
Originally set to go into effect on June 4, the insurer has agreed to put off its implementation until August 6.
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John joined TriMed in 2016, focusing on healthcare policy and regulation. After graduating from Columbia College Chicago, he worked at FM News Chicago and Rivet News Radio, and worked on the state government and politics beat for the Illinois Radio Network. Outside of work, you may find him adding to his never-ending graphic novel collection.