With Blue Cross Billing Changes, Some Patients Could Be Footing E.R. Bills In Full

Texas’ largest healthcare insurer recently said that HMO subscribers may have to pay the whole bill for out-of-network emergency room visits if the health problem isn’t deemed serious enough.

By Alexandra HartMay 7, 2018 1:29 pm| ,

Whenever there’s a medical emergency the very first thing on one’s mind – especially if they’re insured – isn’t typically how much the bill could be. It’s to get help as quickly as possible, then deal with the cost later.

But new rules from insurer Blue Cross Blue Shield of Texas may have some policyholders second guessing whether a trip to the ER is worth it. Blue Cross recently announced a policy – to go into effect in June – that would have patients with HMO plans pay 100 percent of the bill if they go to an out-of-network ER for issues deemed non-emergencies. About 500,000 Texans are covered under Blue Cross HMO plans.

Sabriya Rice, healthcare business reporter for the Dallas Morning News, says that it’s part of a growing trend among insurers who are trying to tamp down on high healthcare costs.

“A few health insurers across the nation, trying to adjust the high cost of emergency room bills, have started trying to encourage people to go to lower-cost centers for things that aren’t emergencies,” Rice says. “So now as a next step, health insurers including Blue Cross of Texas are saying if you go to an out-of-network emergency room and it ends up that it wasn’t an emergency you could be on the hook for 100 percent of the bill.”

So instead of going to ER’s for minor problems, like sprains or cold and flu symptoms, Blue Cross would encourage patients to seek treatment with their primary care doctor, or at an urgent care clinic. But critics say that it can be difficult for patients to determine what should and shouldn’t be considered an “emergency.”

“When you’re home debating in the middle of the night, it can get really confusing,” Rice says, “first trying to figure out if it’s an emergency, and then where to go, if you’re going to an in-network or out-of-network place. That’s exactly the criticism that consumer groups have brought up about these new policies.”

Rice says that it’s a trend that we could see more insurers picking up on as healthcare costs continue to rise.

“We could see more of that to come. This is a real important issue in that it gets at the heart of the conflict – that you can’t really tell what’s an emergency,” she says. “But the cost of healthcare has gotten so expensive in the U.S. that even the insurers are pushing back, and this is how they’re doing it.”