AUSTIN (KXAN) — This week, Blue Cross Blue Shield made some adjustments to its emergency room benefits that mean people could have to pay if they went there for a non-emergency.
The company isn’t changing benefits for its Health Maintenance Organization members, but it is making sure visits to the ER and the treatment people received were for “covered emergency care and were medically necessary.” Starting Aug. 6, the company says it’s also taking extra steps to make sure people are billed correctly and reminding customers that they shouldn’t go to an out-of-network ER unless there is a serious or life-threatening issue.
“This means if you go to an out-of-network ER because it is just a convenient place to get care for something that a person with average medical knowledge would know is not an emergency – like a sports physical – then you may have to pay the entire ER bill,” the company wrote in an announcement on its website.
Emergency medicine physicians like Dr. Nicholas Steinour told KXAN in May that they worry the change could keep people from going to the ER if they really need it or may mean they delay while the weigh whether their insurance company will pay for the visit.
“There are many conditions where seconds, minutes, certainly hours, make a huge difference as far as outcomes go,” Steinour said. “The last thing we want you doing is stalling, calling an insurance company to ask is this OK. That to me is completely inappropriate and really irresponsible.”
Mark E. Escott, Medical Director with Austin-Travis County EMS, is also concerned the change could cost lives.
“If there is concern for a medical emergency, our advice is to Call 9-1-1 and allow our medical professionals from the Fire Department and Austin/Travis County EMS evaluate the individual so that they can make a more informed decision regarding where to seek treatment,” Escott wrote.
Conditions that don’t require an emergency room can either be checked out by a family doctor, or an urgent care clinic if it’s more pressing, which will cost much less than a non-emergency ER visit.
Blue Cross Blue Shield is Texas’ largest healthcare provider.