Scary New Blue Cross Ban On ER Payments Draws Outrage

What happens after you are in a car accident and are rushed by ambulance to a hospital for treatment?

There are 80,000 car wrecks each year in Dallas and Tarrant Counties — about 90 every hour — so this happens a lot here.

But the largest health insurance company in Texas, Blue Cross and Blue Shield, recently announced that its HMO members may have to pay for these super expensive ER bills themselves.

If BCBS concludes that the patient’s medical problem was not that serious to justify emergency attention, he or she will be stuck with payments that often exceed $10,000. No criteria or appeal process have been announced.

This draconian new policy begins on June 4th.

How is this fair?

How does someone know when his pain is so serious that it should be immediately treated or whether he should take a chance and just go home? Is he supposed to know enough medicine that he can diagnose himself and determine if he needs diagnostic testing to rule out a brain injury, herniated disc or heart attack?

This recording of a woman who called 911 in France complaining of pain and who soon died of a heart attack after being brushed off by a dispatcher is shocking — and could become the norm.

The new policy will affect 500,000 of the 5,000,000 Texans who have BCBS.

And a lot more of us, once the other health insurance companies start doing this with their HMOs and PPOs.

Texas doctors contest new policy

This week in a letter from the Texas Medical Association and other major doctor groups, our state’s physicians demanded that the Texas Department of Insurance void the new proposal. They said that “BCBS is asking patients to act as highly trained diagnosticians” and accused the mega company of using “scare tactics.”

Also this week the Texas Department of Insurance demanded more information from BCBS. The state agency requested emergency screening criteria, reviewer’s training documents, and consumer notices so it could analyze the proposal.

In response, BCBS stated two contradictory things:

  •  its members should call 911 and go to an ER if they think they have a medical emergency; but that
  •  the rampant fraud, waste, and abuse in the emergency room setting would now end.

Yes, some people overuse emergency rooms and could have gone to a primary physician or free-standing ER clinic instead. But where can you draw the line when a potentially life-threatening event like a car or truck crash or heart attack is involved?

What happens next?

BCBS has until May 30th to respond to the TDI’s requests. Hopefully it will reverse its position.

If it doesn’t, what will be the point in spending a lot of money for health insurance if your company isn’t going to pay when you most need it?

Last year, Anthem Blue Cross Blue Shield announced that many medical conditions would not be covered in the future. A group of hospitals have filed several lawsuits to prohibit this.

The payment of medical bills is a serious problem, especially when a person is rushed to an emergency room after he is in a car accident. He presumably has no choice as to which hospital the ambulance takes him to.

Here’s a good tip: read your list of providers and know in advance which ERs, EDs and radiology departments are in-network, if you have input into the selection of the hospital. Keep a list on your cell phone.

How a personal injury lawyer can help you

I called a client this morning and she was shocked to learn that her first day of treatment after her car crash totalled over $12,000, with CTs scans and other procedures done. She had guessed her bill would be $2,000.

Although I do everything possible to make insurance companies pay my clients the maximum benefits available, if outstanding medical bills eat up the settlement or verdict, my clients do not get the compensation they deserve.

Therefore I also spend a lot of time making medical providers, especially hospitals, reduce their sky-high bills.

Please contact my office if we can help you after you’ve been injured in a car collision in Fort Worth.

Related posts:

Who pays for your medical bills if you are in a car wreck?

Supreme Court Orders Hospital To Justify Inflated ER Bills

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