July 2017 Newsletter

MAG encouraging patients to act on BCBS ER policy

The Medical Association of Georgia (MAG) is encouraging Georgians who have a Blue Cross Blue Shield of Georgia (BCBS) policy that they purchased through the federal ‘HealthCare’ exchange to research how the insurer’s new policy not to cover non-emergency care that a patient elects to receive in an emergency room (ER) following a retrospective review will affect them and their family members.

MAG is encouraging affected patients to…

– Contact BCBS at the ‘member services’ telephone number that is located on their ID card or log into their BCBS member account at bcbsga.com to confirm what services will or will not be covered under their policy and how much money they will owe if BCBS determines that the care they receive is not deemed an emergency.

– Schedule an annual wellness visit with a primary care physician to minimize the chance that they will need non-emergency care in an ER.

– Contact Georgia Insurance Commissioner Ralph Hudgens’ office at 404.656.2070 or 800.656.2298 or click here to share their concerns or to file a complaint that is related to the new BCBS ER policy. (Note that an online account must be created to submit an email).

– Email their concerns and complaints related to the BCBS ER policy to MAG at workercomp@mag.org.

Nearly 80 percent of the physicians who completed a survey that MAG conducted in June believe that the new BCBS policy will undermine patient care.

Of the 281 physicians who completed the survey, more than 72 percent also said that they do not believe the “average patient is knowledgeable enough to make judgments about what qualifies as a medical emergency.”

One physician worries that, “Patients will be forced to make medical judgments for themselves, family members, friends, etc. without medical training. This is very dangerous.”

Another physician predicts that, “Patients with coronary and stroke symptoms will hesitate to go [to the ER] for fear of having to pay for ER care if they do not have the problem. This is counter to the standard of care.”

One believes that, “The majority of patients are not sophisticated enough to ‘triage’ their own medical issues, and I believe a significant number of patients will delay care [as a result of the new BCBS policy].”

Another one asserts that, “Coverage (or noncoverage) should be based on [a] diagnosis rendered by the ER physician – not a retrospective review by the insurer. How can a lay person know what is life threatening? This is unfair and may lead to medical catastrophes.”

And one physician is convinced that, “Patients will be afraid to go to the ER, even for true emergencies, because of a retrospective review by someone who is trying to maximize profits for the insurance company.”

Nearly 77 percent of the physicians who were surveyed said they have a contract with BCBS, while about 26 percent said they practice in a rural area.

MAG will use the survey results in its efforts to oppose this new policy, which MAG President Steven M. Walsh, M.D., believes “could clearly involve some life-or-death decisions for some of our patients.”

Finally, MAG Executive Director Donald J. Palmisano points out that, “Blue Cross has failed to provide written answers to MAG’s questions surrounding the data that it used as the basis for its new ER policy. The company has also refused to release the diagnostic codes that will no longer be covered under its new policy. And it is unclear whether Blue Cross will expand this policy to other health insurance plans in the state.”

MAG members can contact Kimberly Ramseur at kramseur@mag.org 678.303.9274 with questions about the new BCBS policy.

Click for recording of MAG CEO WABE 90.1 interview on BCBS ER policy

Click for MAG’s fact sheet on the BCBS ER policy