Following the footsteps of other Blue plans, Blue Cross & Blue Shield of Mississippi will change how it pays for emergency room services it decides weren’t emergent after care is delivered, according to the Daily Journal.
Five things to know:
1. Mississippi providers became aware of the proposed policy in a bulletin issued to in-network providers in December. The bulletin said that starting in 2019, “If the office visit level is not in alignment with the diagnosis severity, the payment for the office visit level will be adjusted to align with the diagnosis severity,” according to the publication.
2. Last year, Anthem Blue Cross Blue Shield debuted a similar policy in Georgia, Indiana, Kentucky, Missouri, New Hampshire and Ohio.
3. Emergency physicians in Georgia sued the health insurer for implementing the policy, arguing that when determining if a visit is indeed an emergency, the prudent layperson standard is the general guideline for state and federal law.
4. Mississippi and national chapters of the American College of Emergency Physicians spoke out against BCBS of Mississippi’s proposed policy. They claim the proposed policy will leave hospitals, physicians and patients on the hook for uncovered medical bills. While the Mississippi Insurance Department said it has received physician complaints about the change, no hospitals or physicians have reported inappropriate downcoding by the health insurer.
5. BCBS of Mississippi said the emergency physicians have misunderstood its bulletin.
“In emergency situations, our members should always seek care at the nearest healthcare facility and can trust their care will be covered,” Meredith Bailess, BCBS corporate communications director, said in written statements to the Daily Journal.
Date: January 31, 2019