Feeling a serious, inexplicable ache or pain? You might typically make a trip to the emergency room, but Blue Cross Blue Shield of Georgia customers might be prompted to grin and bear it starting July 1.
On that day, Blue Cross Blue Shield of Georgia will start a new rule for its patients who have its individual (not group) policies. If they go to the emergency room without a legitimate fear of an emergency, Blue Cross is going to leave them with the bill − the whole emergency bill.
There are exceptions for children and for some patients in areas without urgent care clinics. (Those exceptions were relayed to the AJC by a Blue Cross spokeswoman and can be read in our full article here, but were not written into the two-page letter sent to patients).
But ER doctors fear the new rule will endanger lives, frightening away patients who really ought to go to the ER. And the American College of Emergency Physicians thinks the way Blue Cross is implementing the rule may be illegal.
Blue Cross officials say any customer with a legitimate fear of an emergency should go to the ER. If it turns out it wasn’t an emergency, they’ll still be covered if the concern of serious danger was sensible for a “prudent layperson.” It says people who go to the ER when they could be treated at a clinic, or even evaluated over the internet with Blue Cross’s online health app, waste significant amounts of money. The company’s goal, said the spokeswoman, Debbie Diamond, was to save the wasted money to be able to continue providing quality care.
Blue Cross is the only insurer on the Obamacare exchange market in 96 of Georgia’s 159 counties.