The change will affect BCBSTX’s fully insured group and retail health maintenance organization members with out-of-network ED claims filed after June 4. Those members may be on the hook for the entire out-of-network ED bill if they use the facility for care the insurer deems not serious or life-threatening.
“We want to make healthcare affordable for our members, and to do so, we have to be good stewards of their money,” a BCBSTX spokesperson told Becker’s Hospital Review in April, when news of the policy change broke. “Some of our members are using the ER for things like head lice, thinking it is more convenient, rather than serious or life-threatening issues. This not only drives up costs for our members [and all Texans] but uses limited ER resources for conditions that are not serious or life-threatening.”
Lonnie Schwirtlich, MD, an ER physician and a Texas Association of Freestanding Emergency Centers member, told Spectrum News Austin the policy will negatively affect patients.
“This will create deaths. This will kill people. People will die because of this,” he said. “This for sure will cause people to think twice and not go to the emergency room.”
In a statement to Spectrum News Austin, the Texas Medical Association also raised red flags about the policy. “We do not believe patients should be expected to self-diagnose to determine whether their symptoms are serious enough to warrant an emergency department visit,” the association said.
Esteban Lopez, MD, the CMO for BCBSTX, said the insurer doesn’t have any expectation that members will be self-diagnosing, the report states.
The Texas Department of Insurance will be seeking answers from BCBSTX about the policy before it takes effect June 4.
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