Blue Cross Blue Shield Won’t Cover the Cost of Some ER Visits

Blue Cross Blue Shield (BCBS) of Texas is putting some of its policyholders at risk and on the hook for Emergency Room visits. As one of the nation’s largest health insurance providers, other insurance carriers are likely to follow BCBS’ example by implementing similar policies of their own serving to increase your cost of healthcare.

America’s ER wants the public to be aware of what their insurance carriers are trying to do so they can speak up and fight back instead of getting caught in the middle of these dangerous and illegal policies. By refusing to cover the cost of care, insurance companies are only looking to increase their own profits by shifting the burden of cost of healthcare mostly on the patient and further limit your access to timely healthcare.

This series of articles will expose what lengths insurance companies will go to are doing to protect their profits and coming changes to health insurance, changes that could leave you footing the entire bill of an emergency room visit even if you have health insurance.

The New Policy

If Blue Cross Blue Shield of Texas decides that an ailment was not an emergency, it will not cover the cost of an out-of-network emergency room visit, leaving the patient to cover most or all the cost of the visit, a bill that could easily be in the thousands. By federal law, out-of-network emergency room visits must be covered by insurance companies because in an emergency, policy makers know it is more important to save time, and potentially your life, by going to the nearest and most convenient licensed emergency room as opposed to worrying about if an emergency room is in or out of network.

Blue Cross will still cover emergency visits. What it won’t cover is emergency room visits for ailments it later deems as non-emergencies. This means that if that chest pain you were having ended up being a non-emergent condition like gastritis, even though the symptoms you were experiencing felt like an emergency to you and worth having evaluated to be sure you were safe, BCBS will say it wasn’t and will refuse to pay your bill.

Who does this affect?

This new policy applies to retail HMO members of Blue Cross and Blue Shield of Texas. It’s estimated that around half a million Texans could be affected.

When does this policy go into effect?

The start date is up in the air. Originally, Blue Cross planned to put the policy into effect June 4, 2018, but concern and pressure from the Texas insurance regulatory office, namely Texas Insurance Commissioner Kent Sullivan, has delayed the implementation of the policy. The policy was scheduled to go into effect August 6, 2018.

Why is Blue Cross implementing this Policy?

Blue Cross says the policy is to keep the cost of insurance down by keeping people from going to the emergency room for non-emergencies such as head-lice and sore throats. Blue Cross lays out what it considers an emergency here.

Some consumer advocates and healthcare professionals see the policy as putting a burden on patients at their most vulnerable moment. A patient, with no formal medical training, must decide in the moment, while they are likely frightened and most concerned about their symptoms, if something is an emergency. In essence, BCBS is expecting patients to self-diagnose without the benefit of medical training, advanced lab and radiology testing and physician input.

While Blue Cross says it will base these decisions on the intent of the patient and not the final diagnosis, some healthcare professionals worry that the policy will cause a “chilling effect” by “training” patient behavior to avoid medical care altogether for potentially dangerous conditions because they afraid of what it may cost.

How does this policy affect America’s ER?

America’s ER is doing its best to provide relevant, easily accessible and understandable information about the upcoming policy change. America’s ER is an emergency room as well as an Urgent Care Center housed in the same building.

When a patient visits America’s ER, the attending ER board certified physician determines if the Emergency Room or Urgent Care Center is the most appropriate department for treatment based on a patient’s symptoms, vital signs and physical examination.

These are some conditions that are considered emergencies and would be treated in the ER:

  • Abscesses/Boils/Spider Bites
  • Abdominal/Stomach Pain
  • Accidental poisoning or Ingestion
  • Allergic reactions (severe), Hives, Anaphylactic shock
  • Animal Bites
  • Asthma and breathing problems
  • Back Pain/Sciatica (severe)
  • Blood clots
  • Bronchitis and Pneumonia (severe)
  • Burns
  • Cellulitis, Sepsis, Staph/MRSA and other sever infections
  • Chemical exposure
  • Chest pain or Heart attack
  • Congestive Heart Failure Dehydration or shock
  • Diarrhea
  • Dislocations
  • Dizziness, Vertigo or Loss of consciousness
  • Eye injuries
  • Falls
  • Foreign body removal
  • Fractures/broken bones
  • Head Injuries
  • Headaches/Migraines (severe)
  • Heat Strokes
  • High fever
  • High Blood Pressure/Hypertension
  • High Blood Sugar/Diabetic Coma
  • Lacerations/Injuries/Bleeding
  • Nausea/Vomiting
  • Palpitations/Tachycardia/Arrhythmias
  • Pediatric Illnesses/Injuries (severe)
  • Pneumonia
  • Seizures
  • Shortness of breath/COPD
  • Sports Injuries
  • Strokes/TIAs (Transient Ischemic Attacks)
  • Sprains (severe)
  • Urinary Tract Infections (severe) and Pyelonephritis

These are some conditions that are considered non-threatening emergencies and would be treated at an urgent care:

  • Allergies (seasonal)
  • Asthma (minor)
  • Back Pain (minor)
  • Bladder Infections (simple)
  • Cold/Flu Symptoms (without fever)
  • Contusions/Minor Injuries
  • Cough (without fever)
  • Ear Pain (without fever)
  • Hay Fever
  • Insect Bites/Stings (without reactions)
  • Minor Scrapes/Cuts/Abrasions
  • Pediatric Illnesses/Injuries (minor)
  • Pink Eye
  • Poison Ivy/Simple Rashes
  • Sinusitis
  • Sore Throat (without fever)
  • Sprains/Strains (minor)

Insurance, and these new changes, are confusing but don’t feel overwhelmed. We’ve broken down all the important things you need to know.