BCBS enacts policy on ER visits

Insurer won’t pay if less expensive treatment was found possible

Blue Cross and Blue Shield of Texas will begin a controversial new program Monday in which it will not pay any expenses for an out-of-network emergency room visit if it is later determined the patient should have gone elsewhere for treatment.

Originally, the measure was set to roll out June 4, but vigorous complaints from the public and physicians, as well as concerns from the Texas Department of Insurance, delayed it for 60 days for further review.

Blue Cross and Blue Shield of Texas officials and TDI confirmed late last week the deeply contentious program will now launch and that any sticking points have been resolved.

The new measure is expected to affect about 500,000 Texans with Blue Cross and Blue Shield health maintenance organization (HMO) plans.

Claims will be scrutinized after the fact by a medical director hired by the insurer to determine the reason a patient chose going to the emergency room and whether treatment could have instead been handled at a less expensive clinic or by a family physician. The company will also look for overtreatment.

“We have, quite frank-

“TDI is allowing for insurance consumers’ rights to be violated and potentially putting everyday Texans in clinical and financial distress.”

Rhonda Sandel, CEO of Texas Emergency Care Center