Blue Cross in Alabama says it won’t quit paying for some ER visits | AL.com

Starting in July, Blue Cross Blue Shield of Georgia will stop covering emergency room visits that the health insurance provider deems unnecessary.

Don’t expect Alabama to follow suit, however.

The Georgia Blue Cross policy is an effort to keep people from using emergency rooms as their source of primary care. Instead of a costly trip to the ER, the insurance provider is encouraging customers to use urgent care clinics, retail health clinics and BC/BS’ LiveHealth app or online site, all cheaper alternatives than a trip to the hospital.

“This is not to discourage somebody with an emergency condition who needs to go to an ER to go there,” BC/BS spokesperson Debbie Diamond told the Atlanta Journal Constitution. “Health care is becoming more and more expensive. It’s a way to make sure that people are getting quality and affordable care.”

If a person goes to an ER for something other than what a “prudent layperson” would deem as a serious danger, BC/BS in Georgia said it won’t cover the cost. There are exceptions – the rule won’t apply to children 13 and younger; members who don’t have urgent care clinics within 15 miles; or ER visits made on Sundays or major holidays.

 

While Georgia is moving ahead with efforts to reduce unnecessary ER visits, Alabama BC/BS has no plans to implement a similar policy, according to spokesperson Koko Mackin.

“Blue Cross and Blue Shield of Alabama is not ending coverage of ER visits,” Mackin told AL.com “We remain committed to providing our members access to the right medical care in the right setting at the right time, whether that is in the doctor’s office, an urgent care clinic or the emergency room.

“We will continue to cover our members’ emergency rooms visits according to their benefit plan,” she added.

According to the National Center for Health Statistics, Americans made some 130 million visits to the ER last year, 37 million of which were for injuries and 12 million of which resulted in a hospital admission. Alabama reported 440 emergency room visits per every 1,000 residents; Georgia had 430 ER visits per 1,000 residents in 2015, the most recent data available.

Recent government data showed more than 10 percent of all ER visits were non-urgent in nature.

Source: Blue Cross in Alabama says it won’t quit paying for some ER visits | AL.com

Posted in ER Billing, Government Regulations, Industry Updates