Blue Cross Warns Patients They May Be On Hook For Their ER Visit
Thousands of Texans may want to think twice about their next trip to the emergency room.
The largest health insurer in the state, Blue Cross Blue Shield of Texas, will notify some policy holders they’ll be responsible for paying the entire bill of an emergency room visit for reasons that are determined to not be life threatening or serious.
In a memo, the company says “some of our members are using the emergency room (ER) for things like head lice or sprained ankles.”
It goes on to say, “doing so not only drives up costs for our members, but uses limited ER resources for conditions that are not serious or life threatening. We want to make health care affordable for our members.”
Starting June 4th, fully-insured groups or retail HMO members may be required to pay for the entire ER bill if they go to an-of network ER as a convenience for a condition they don’ think is serious or life-threatening.
President of the DFW Hospital Council W Stephen Love says misuse of the ER has been a problem for some time and leads to higher health care costs.
He says the other problem is confusion about where to get immediate health care. Many people go to out-of-network, freestanding emergency rooms, under the impression they’re going to in-network urgent care clinics.
“If you walk into a freestanding ER and said, ‘do you accept insurance?’ most would say yes. The real question you should be asking is, ‘do you take insurance that’s in network and will I not be billed out of network?’ Sometimes, people don’t know enough to ask those detailed type questions,” Love said.
Dallas freelance hair and makeup artist Cheryl Smith purchased a Blue Cross HMO plan, which she says, requires with monthly premiums higher than her monthly mortgage payments.
Smith feels the policy change creates an extra burden on the consumer to decide what’s considered a covered “emergency.”
“I’m paying for this but I’m scared to use it because I don’t think our insurance company is going to have our back on this,” says Smith.
Dallas Morning News Business of Healthcare Reporter Sabriya Rice takes an in-depth look at the changes here.
To learn more about BCBS emergency care, visit its SmartER Care website.
It would appear that BC is putting the decision as to what is an emergency and requires a trip to the ER and what doesn’t not … on NON MEDICALLY TRAINED GENERAL PUBLIC and if the person does not evaluate their condition correctly could be given a bill for hundreds or THOUSANDS OF DOLLARS.
Recently it was stated that 60% + of the population could not afford a $500 emergency cost and/or a $1000 emergency medical bill. According to this, a person going to ER, who it is determined – after the fact – did not have a “real health emergency” … could throw the family’s financial status into a financial crisis ?
Filed under: General Problems
The insurance companies only want to cover HEALTHY people!!
Before the ACA was enacted. Some state Medicaid programs had similar policies
And what happens when the E.R. MISSES,,,IE,,my e.r. missed pancreatits,gallstiones,,broken ribs,enlarged spleen,broken blood vessel to spleen,,,soo that’s like ,,6 misses in 6 visits to my E.R,,,soo then what bluecross????Turn around and sue the hell out of u for being stupid, ignorant and inhumane…Medical imagining does ,”miss,” things,dahhh,,,maryw
I recently was told by BC/BS of FL, after talking to the BC/BS nurses, to go either to an urgent care or the ER within 6 hours. I went to the urgent care and the doctor (an ER doctor moonlighting) sent me to the ER. He said my symptoms could be heart or GI and that urgent care was unable to determine. So off to the ER. I was fast tracked in case it was a heart condition. It turned out to be GI. So sent by the nurse from BC/BS phone line and the off duty ER doc to the ER and now I could be stuck with the whole bill if I lived in TX?!!!
This is absurd. If after the fact they say, it wasn’t a heart issue and they refuse to pay. Why will anyone go to the ER? Even now with BC/BS FEP. The ER is only 100% paid if you go there within 72 hours of an automobile accident. For ALL other emergencies; heart attacks, strokes, compound fractures, etc the insurance will not cover the whole bill. They now have a couple hundred dollar deductible. I already see this as keeping away real emergencies. What is our world coming to?
Why aren’t doctors fighting all this crap much more than they are? They will be big losers when no one will have surgery because pain relief is going to not be guaranteed. They will lose out when patients will die rather then go to the ER as they don’t want to lose their homes. Frankly, I look at the insurers bringing in 1 billion in profits and yet they are cutting down medicine to where people say they will not take the risk.
People can no longer count on healthcare. Doctors can no longer count on patients.
We are turning into a society that no longer values the lives of its citizens- PERIOD.
Unfortunately, a nurse or doctor telling you to go to the ER. Is no guarantee your condition will meet your insurance companies criteria for them to psy for the visit.
Like Dr.Kline state in his speech at the congressional hearing.Its people who are NOT m.d. making decision about our healthcare that have literally destroyed healthcare,,and have literally KILLED peple,fathers,mothers,children etc,,dead,because someone w/no medical knowledge think they have the right to decide who lives or dies in forced physical pain,,case in point below,,maryw
Exactly HOW is the average person supposed to know if an ankle is sprained or broken? The first thing the ER would do I’d XRay it because they don’t know either. And this was the example used for people who should NOT use the ER!