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."
Seriously, out of network balance billing is a growing phenomena that can create havoc with a patient's health and finances.
What are your thoughts and opinions on this subject?
When I was at BCBSTX, they had regular board meetings with doctors to discuss insurance/patient matters. I wonder if they stopped doing that. Seems that this would never have been approved by that board.
Ok folks.
The reality is that health care has to be rationed. We cannot provide 100% care for 100% of the people. But no one can say that, politicians, insurance companies, doctors, and even us.
When I grew up it was rationed. We knew the doctor would cost money and we made decisions accordingly.
Lots of ER’s already end up giving free to to 30 or 40% of their patients thanks to EMTALA. This bullshit ( which we went through in the 80’s is going to be a major problem.
“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.”
Just went thru major surgery at in Network Hospital..
The only thing the Ins. Company didn’t cover completely and I have been billed for are blood tests that were sent out which doesn’t make sense to me. I was treated at an in Network Hospital.
But I aint complaining after seeing what the Ins. Company did pay...
If the healthcare industry was prosecuted for it’s blatant violations of 100 year old U.S. laws, costs would drop 80% and this would not be an issue.
It seems as though all payers are trying to discover creative ways to avoid reimbursing health care providers. And, the threat of disrupting access to care is very real. For example, many people are now calling EMS to determine if they’re sick enough to go to the emergency department, lest they be exposed to their outrageously high Obamacare deductibles. One universal law of emergency medical care is that “eventually, all chest pain subsides.”
Part of the problem is that ER charges, even for non emergency care are way higher than if a person went to a walk-in clinic or GP. The solution would seem to be a change in coding so that insurance covered it at the Non ER rate. Not running every single test under the sun would reduce costs too.
I understand people should not use the ER for non emergencies but in some cases that is the only care available on short notice during certain hours.
Yup
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About 25 years ago a hospital billed us $35 for a single non-medicated cough drop. It was nothing more than a piece of penny candy. Today I’m sure that cough drop would cost at least $200.
Blue Shield dumped me 6 years ago. I was a paying customer for over 20 years.
Thanks Blue Shield and Obama.
Now they call me 3 times a week!
I get that hospitals outsource anesthesia and often their doctors, but I can't even understand what some of these charges are for. Except to inflate the bill of patients with insurance.
I only hope that the hospitals and insurers are as thorough with my cancer biopsies and they are with the wallet biopsy.
This is like using a howitzer to kill a mosquito.
If utilization rates are too high because some patients are abusing the system, raise the co-pays for unnecessary visits. And keep raising them until the problem is reduced.
And then cut areas without 24/7 urgent care coverage some slack.
I needed an MRI a few months ago, I was referred to one of the Local Hospitals, to use the Wide Bore Machine was going to cost me $948 out of pocket. I called a local imaging center, and to use their Open MRI was $450.00. When I asked why the difference, all the manager at the Imaging center could say is that they were independent from most of the costs hospitals incur because of all of the governmental regs.
That’s what happened with my BCBS Texas plan. Last year an ER visit was $50. This year it is $200. It definitely makes us double check if we need an ER visit.
Unfortunately I have three kids, two of which (oldest and youngest) were born premature and have, at least in the past, required several ER visits late at night due to problems breathing and other issues.
Fortunately they are getting older now (6, 3, 2) and many things can be taken care of at Urgent care when their pediatrician’s office is closed.
“if you are too stupid to determine and to understand that going to an ER for something NON-EMERGENCY is going to cost you more, and possibly A WHOLE LOT MORE”
One problem is, many who use the ER for a non-emergency DO understand what they’re doing.
They are uninsured or on Medicaid and will pass their costs on to taxpayers and the insured. They come to the ER because they would have to pay a doctor bill otherwise.
I had to go to the ER late one night for a broken finger, and I noticed entire families there for the little one that had a cough.
It was obviously a family affair for some folks. They even brought dinner for their crew in some cases.
Exactly. In a system of infinite resources, somebody is going to be the “death panel.” Our choice is whether it’s CMS or BCBS’s boardroom.
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