Highlights on this story:
- BCBS's discretionary ER policy, which was set to roll out June 4, will step up scrutiny of out-of-network ER claims. The insurer will deny any claims it determines after-the-fact to be nonemergent.
- The controversial ER policy has received a lot of pushback from physicians, providers and state insurance regulators who have voiced concerns that the program could negatively affect patients.
Blue Cross Blue Shield of Texas will delay implementing a controversial emergency room policy for 60 days as pushback and questions mount, according to the Houston Chronicle.
Here are six things to know:
- BCBS’s discretionary ER policy, which was set to roll out June 4, will step up scrutiny of out-of-network ER claims. The insurer will deny any claims it determines after-the-fact to be nonemergent. In other words, if it isn’t a true emergency, they will not pay for it.
- The controversial ER policy has received a lot of pushback from physicians, providers and state insurance regulators who have voiced concerns that the program could negatively affect patients.
- Texas Insurance Commissioner Kent Sullivan and BCBS President Dan McCoy, MD, met May 29 to discuss the rollout of the policy. In this meeting Dr. Sullivan agreed to the delay.
- On May 31, the Texas Department of Insurance sent a two-page letter to BCBS outlining specific questions the insurer must address before implementing the program. Some of the questions include how the insurer will retroactively review a patient’s decision to go to the ER and what kind of appeal process would be available to patients and providers if a claim is denied. “This is a situation where the devil is in the details,” an Insurance Department spokesperson told the Houston Chronicle.
- BCBS released a statement saying it was pleased to work with the Texas Insurance Department in the next 60 days to clarify any information. “During this time BCBS-TX will provide any further information TDI or Commissioner Sullivan requests while continuing to educate our members on the importance of appropriately using emergency services,” a BCBS statement read.
- The ED insurance policy now is slated to go into effect Aug. 6.
Date: June 01, 2018