When it comes to emergencies, you don’t have time to second guess, but that might change when a new policy by Blue Cross and Blue Shield of Texas starts in June.
Under the new policy, patients would have to pay the full bill on out-of-network emergency room visits if Blue Cross and Blue Shield later determine the issue was not serious enough.
“They’re asking patients to essentially diagnose themselves,” said Doctor Gillian Schmitz, an emergency room doctor and Board of Directors for the American College of Emergency Physicians. “The insurance company is retrospectively saying several days later from a piece of paper, with very little – if any – medical training, determining what is an emergency and what is not.”
The policy officially takes effect June 4, and Texas would be the seventh state with the policy.
Blue Cross and Blue Shield is the largest health insurance company in Texas.
This policy could affect more than 500,000 policy holders.
Schmitz is worried patients will hesitate to go to the emergency room for real emergencies if they’re scared they might be charged the full bill, putting lives at risk.
“There’s no question in my mind patients will die because of this policy. This is an attack on emergency medicine, and it’s an attack on patients,” Schmitz said.
Schmitz says insurance companies are required by law to pay for emergency coverage.
Doctors and groups have raised legality concerns to the Texas Department of Insurance, but the next step may be at the State House.
“We’re already preparing for our legislative solution next session. You wouldn’t think you’d have to change a law based on something that already is a law,” said Brad Shields, the Executive Director of the Texas Association of Freestanding Emergency Centers.
CBS Austin reached out to Blue Cross and Blue Shield of Texas, but they have not responded.
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