Blue Cross Blue Shield Will Limit GA Emergency Room Coverage for Individual Health Insurance Plans

[TexasTowelie]

As has been reported now by WABE, the Atlanta Journal-Constitution, Becker’s Hospital Review, The Fiscal Times, and The Intercept, Blue Cross Blue Shield of Georgia sent letters last month to individuals who purchase their plans on the health insurance exchanges stating the company will no longer pay for services rendered in emergency rooms that it deems unnecessary.

Blue Cross Blue Shield hopes this policy will prompt consumers to use primary care or urgent care for non-life threatening health issues, pointing out that emergency services are meant for true emergencies. Emergency care is more expensive than most other types of health care, and most emergency rooms are already handling a full load with actual emergency situations. This change in policy is also meant to save Blue Cross Blue Shield and hospitals money, according to the insurer. They’ve built in safeguards, so the policy excludes Sunday visits and visits on major holidays, those who lives more than 15 miles away from an urgent care clinic, and anyone under the age of 14. The AJC notes that while Blue Cross Blue Shield relayed those exceptions to their reporter, they were not listed in the letter sent to customers dated May 19, 2017.

If you’re thinking, “well duh, of course you shouldn’t go to the emergency room for a cold,” I agree, and I am aware that a small percentage of patients go to the emergency room if they so much as stub their toes. Of course, the are some murkier areas than black and white examples, particularly outside of our urban and suburban areas of the state.

As has been discussed several times on this blog, rural hospitals in Georgia are in trouble, and many are closing. Rural hospitals rely on payments from insurers to stay afloat. Now that Blue Cross Blue Shield will force consumers to pay out of pocket for visits classified as unnecessary, there is a worry that hospitals won’t get paid for some — if not many — of the treatments provided that fall under this category, exacerbating their financial woes.

Read more: https://www.georgiapol.com/2017/06/02/bcbs-limit-georgia-emergency-room-coverage-plans/