Blue Cross Blue Shield of Georgia won’t cover ER visits it considers unnecessary
For its individual market customers, Blue Cross Blue Shield of Georgia is saying it won’t pay for emergency room visits for conditions which aren’t an emergency.
The Atlanta Journal Constitution reported the insurer’s policy, which will go into effect July 1, defines an emergency as what a “prudent layperson” would think poses a serious danger, with Blue Cross making the final decision on what meets that standard. The goal, it said, was to discourage patients from going to the emergency room (ER) for what could be handled by a primary care physician, urgent care clinic or the insurer’s own telehealth app.
“This is not to discourage somebody with an emergency condition who needs to go to an ER to go there,” said company spokesperson Debbie Diamond. “Health care is becoming more and more expensive. It’s a way to make sure that people are getting quality and affordable care.”
Patients and physicians don’t seem pleased. Blue Cross is the only insurer for Affordable Care Act exchange customers in 96 of Georgia’s 159 counties, and with no other insurance options, the concern is those customers may not visit the ER for fear of being stuck with a hefty bill.
“If this is fully implemented, I think we’re going to have deaths out there because of it,” said Emory University Hospital emergency medicine physician Matthew Keadey, MD.
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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.