Posted on 05/10/2018 6:41:38 AM PDT by buckalfa
AUSTIN, Texas -- Doctors are criticizing Texas' largest health insurance provider for a controversial new billing process.
Blue Cross Blue Shield announced that starting June 4, Texans who go to an out-of-network ER might have to pay all of the costs themselves if the visit isn't not deemed to be necessary.
"This will create deaths. This will kill people. People will die because of this. This for sure will cause people to think twice and not go to the emergency room,” said Dr. Lonnie Schwirtlich, an ER doctor and member of the Texas Association of Freestanding Emergency Centers.
The Texas Medical Association also has spoken out against the new billing process.
A coalition of members wrote a letter to the Texas Department of Insurance, in part stating: "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."
The new rules would only affect about one-tenth of policy holders in the state: those who hold plans limiting visits to "in-network" providers except in emergencies.
Blue Cross Blue Shield said it's just trying to prevent emergency room abuse.
"There are a variety of different ER visits that are coming in as convenience," said Dr. Esteban Lopez, the Chief Medical Officer for Blue Cross Blue Shield Texas.
The insurance provider said people are coming in to the emergency room for things like head lice or physicals, but they maintain symptoms of life-threatening injuries are still covered.
"We do not have any expectation that the member would be self-diagnosing," Lopez said.
Some say Blue Cross Blue Shield’s move is part of a national trend. A similar policy has been rolled out in six other states by Anthem, a different health insurance provider, which has chosen to not cover non-emergency ER visits for some of its policy holders.
Meanwhile, those against the process change say it's solving a problem that doesn't exist, and want the Texas Department of Insurance to stop it.
A spokesperson from the Texas Department of Insurance said the agency does have questions about the change, and that the agency will be "seeking answers before it goes into effect June 4."
Yes, just like certain foods, alcohol, clothing, houses, etc....some people BUY better things than others, because they have more money!
That's exactly the reason. If insurance went back to it's origins and covered only hospital stays ... or even just cover catastrophic care ... the cost of medicine would plummet, IMO.
BC/BS has been one of the big backers in socialized healthcare. In short they are as much as responsible for driving up cost as any one especially when the HMO Acts became law which put the nail in the coffin of affordable true insurance. BC/BS using HMO’s rather than private insurance people could once afford took over a good chunk of healthcare. My last employer went from BC/BS Hey Moe to self insured covering preventive care and with a $500 yearly deductible covered 80% of all else. We got out of pocket expenses paid back in days not weeks. Our company saved a fortune.
When I started there, they were pushing the HMO very heavily along with their PPO plans. By the time my tour was done, they had dropped the HMO and put more stock into HSAs.
Free standing emergency rooms not associated with hospitals are total ripoffs. My wife went to one when i was out of town and didn’t realize they were ripoffs. Charged her $900 for just a few services. After I called them, the cost was dropped to $350. I told them they could take it or sue us; and I would demand a jury trial.
My husband is uninsured. He went to the ER with possible stroke symptoms. We got the bill we paid. We did get a cash discount but nowhere near the discount you would see on an insurance EOB. The truth is that hospitals inflate their charges. Then Medicare pays according to their rates. Private insurance also pays according to their contract rates. So it is only fair that self pay gets to negotiate as well.
Now if the billed charges reflect the true cost of health care and everyone (who pays) is paying a negotiated rate at some point the hospital will have to shut down because they cannot afford to operate. More likely the hospital has figured out the true cost and ups the bill to cover non-paying indigent care. Which at one point was also figured into the costs. But with the rise of care for illegal immigrants and lower reimbursements for medicaid patients that is becoming more and more untenable.
So while hospitals are hoping for more money from providers, providers are wanting to put more restrictions on payments. You can guess who ends up getting shafted, the patient who has faithfully paid premiums.
As opposed to those Medicaid oversee who call an ambulance to transport themselves and their brood to the ER to get treated for the sniffles. Yes it happens. Daily. And if you pay taxes you are paying for it.
And the need to treat the uninsured for free. Oh and all the illegals...
The uninsured do not get treated for free. Unless you are indigent and even then you will be told where you can get help with paying the bill. Hospitals do not like to write off entire bills so they try to at least make it so they get partial payment. But if you are non indigent and uninsured you get billed and you pay. It may be a discounted amount just as insured patients pay a discounted amount but you do not get free health care.
The lab was out of network. It is important if the surgery is non-emergency surgery to find out if all providers are in network. If they are not you should be able to negotiate a reduced rate with the provider once they have gotten the payment from insurance.
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