Sat
Jun 3 2017
11:41 pm
Blue Cross Cracks Down on ER Visits, Angers Doctors
By: jbr

Sometimes, how can you tell?

If this becomes the norm, it seems there will need to be 24x7 walk-in clinic care available. Or maybe 5 pm to 7 am thru week and 24 hours on weekends.

"But starting July 1, 2017, you'll be responsible for ER costs when it's NOT an emergency. That way, we can all help make sure the ER's available for people who really are having emergencies."

The 2010 Affordable Care Act lays down strict rules for covering emergency room visits. ACEP said the insurance industry is taking advantage of the Trump administration's disregard for the ACA to push the boundaries.

Doctors want to work 9 to 5 and patients have few other choices outside of those hours, he said.

Major Insurance Company’s Payment Decision Angers ER Doctors

Topics:
bizgrrl's picture

Dr. Becky Parker, president

Submitted by bizgrrl on Sun, 2017/06/04 - 9:01am.

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.

jbr's picture

Emergency room doctors are

Submitted by jbr on Sun, 2017/06/04 - 11:08am.
(in reply to bizgrrl)

Emergency room doctors are questioning letters than have gone out to some Anthem Blue Cross/Blue Shield members in three states that threaten a crackdown on reimbursements.

"Save the ER for emergencies — or cover the cost," reads a letter sent last month to Blue Cross and Blue Shield of Georgia members.

Similar letters have gone out to members of plans owned by Anthem, Inc. in Missouri and Kentucky.

B Harmon's picture

FWIW

Submitted by B Harmon on Sun, 2017/06/04 - 11:08am.

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)

tlc's picture

Interesting Demos

Submitted by tlc on Sun, 2017/06/04 - 8:11pm.

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.

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