Dr. Becky Parker, president of the American College of Emergency Physicians (ACEP) "said it's not reasonable to expect a patient to know the difference [between an emergency and non-emergency]. "I don't know and you don't know if that is a heart attack, a blood clot, or a collapsed lung unless I see you in the emergency room".

So true.

We have BC BS TN and haven't rec'd this letter. Maybe we should review the policy to see if it got slipped in at renewal. Very scary. I cannot count the times my doctors have said go to the ER if this or that happens. When you get a recording at their offices they say call 911 if it is an emergency. How can I define an emergency? It is an emergency to me.

I know this is all anecdotal but I will share some of my experiences first from working in the ER decades ago, working for insurance companies, and most recently reviewing ER visit records to compare admitting symptoms and final diagnosis.

First, if you ever get a denial for an ER visit, ask for an appeal. You may need to have a physician write to the insurance medical director, but it is worth it. Be a squeaky wheel, drive them crazy. Report it to the TN state dept of insurance.

Second, insurance companies have been scrubbing ER claims for decades. The most common denials were for bladder infections, sore throats, constipation (abdominal pain), chronic back pain (usually asking for narcotics). I am sure there are more, but those come to mind now.

Third, having worked in the ER (again very long ago) I was always surprised by the number of people that came in at 9 pm on a Friday for a sore throat they have had for 4 days, and other symptoms that have been ongoing. This has changed, and now when someone goes to the ER, after they have been "triaged" to determine the nature of the emergency, if it is not an urgent issue, they will be told that the insurance company may deny the claim and the hospital may ask for payment upfront.

(disclaimer, I only have experience with one hospital here in TN on this issue)

I did a little digging. The median household incomes for these 3 affected states (2014 figures) rank them at 33...47...and 50. Even Guam, an American territory, bests Mississippi (#50). People in these states will be more likely than most U.S. citizens to question their symptoms rather than risk being hit in the wallet, should those chest pains not be a heart attack, after all. Or, is it?

Trump won all 3 states. He promised them the very bestest, absolutely terrifically amazing healthcare like you wouldn't believe...and they bought into it.