Blue Cross Will No Longer Pay Expenses for Out-Of-Network Emergency Room Visits - NBC 5 Dallas-Fort Worth

Blue Cross Will No Longer Pay Expenses for Out-Of-Network Emergency Room Visits

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    Blue Cross Won't Pay for Out-Of-Network ER Visits

    Many members of the state's largest health insurer, Blue Cross Blue Shield, will now have to pay their entire bill if they go to the emergency room for the wrong reasons. (Published Monday, Aug. 6, 2018)

    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 live 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 group 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," says Love.
    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 because I don't think our insurance company is going to have our back on this," says Smith.
    Dallas Morning News Business of Health care Reporter Sabriya Rice takes an in-depth look at the changes here.
    To learn more about what BCBS resources, visit its SmartER Care website.

    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. 

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    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 August 6, retail HMO members will 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.

    A spokesman for Blue Cross Blue Shield of Texas sent NBC 5 the following statement.

    "Over the last two months, Blue Cross and Blue Shield of Texas (BCBSTX) has diligently worked with the Texas Department of Insurance, providing all requested information regarding a process – being implemented today – to review emergency room charges of our retail and group HMO members.

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    Combined with continued education and information, we believe this thoughtful, multi-step review process will provide protection for our members from inappropriate billing, egregious charges and fraud, waste and abuse by out-of-network emergency departments."

    BCBST says the review process with be multi-level and they will review each medical record so they are taking into account the symptoms that caused the need for the visit. BCBST also says they will place any claim in pending, not deny, while it goes through the review process.

    To learn more about BCBS emergency care, visit its SmartER Care website.

    Rhonda Sandel, a Board member of the Texas Association of Freestanding Emergency Centers (TAFEC) issued the following statement in response to BCBSTX's new HMO Emergency Benefit Management Process:

    "While the reasons for issuing this intimidating, anti-patient, anti-ER policy were presented as positive (saying that non-essential ER use by members “drives up cost for our members” and taxes “limited ER resources”), in reality, what they were doing then and now served to accomplish just two things—and neither are to the benefit of Texans: drive down the use of ER care (regardless of need) and increase the profits of Texas’ largest insurance provider at the expense of everyday Texans and their medical providers."

    To read the entire statement, visit the TAFEC website.

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