Some Texas medical societies say the insurer’s pending review process change would scare patients into not seeking emergency care and could be deadly.
By: Allison Lee
June 4, 2018
The largest health insurer in Texas was set to change a review process on Monday. But it has been delayed until August 6th, after getting backlash from physicians in Texas.
If the new process is launched, Blue Cross Blue Shield of Texas said its 500,000 HMO members may have to pay the entire cost of an out-of-network emergency room bill, if they go for something not serious or life-threatening.
The insurance carrier said the stricter review policy is designed to help make health care costs more affordable. In an April 18 memo, Blue Cross first explained the change by pointing to examples of people who use out-of-network ERs for things like head lice or sprained ankles.
The push-back from Texas physicians
The Texas Medical Association and 18 other Texas medical societies sent a letter to the Texas Department of Insurance (TDI), in protest of the change.
The letter states, in part:
“BCBSTX is asking [patients] to diagnose their symptoms at a critical and emotional moment, when time can be of the essence. As a result, it is very likely that extremely ill patients will not seek emergency medical care while, bluntly, their conditions worsen or they die…. Scaring them into avoiding emergency care seems a heavy-handed approach that could be detrimental to good patient care.”