Mansell, Engel & Cole

Controversial then, controversial now: insurer’s program rolled out

A program just rolled out by mega-insurer Blue Cross Blue Shield in Texas is certain to garner closest attention in Oklahoma and other states. The initiative, which targets emergency room visits by insured policyholder, has been termed “deeply contentious” and “intimidating” by critics.

There are legions of those. They view the BCBS measure as being fundamentally anti-patient and chilling for the effect that it is widely expected to have on patient care visits and treatment.

That is this: a mass balking by those in immediate need of medical care, who will now opt to forgo it out of fear that their decision to seek treatment will undergo an after-the-fact evaluation and not be covered under their insurance policies.

What BCBS now mandates is post-treatment scrutiny from an internal medical director of all the particulars relevant to an emergency room visit, including whether it was an out-of-network event and whether treatment costs were arguably high. Blue Cross principals say that the company simply won’t pay up – perhaps not at all – if it finds a condition was overtreated or that an insured should have found an in-network facility or even waited to schedule a routine appointment.

That rhetoric has many of Texas’ approximately 500,000 BCBS insureds more than a bit nervous. Critics argue that the policy will stop even seriously ill people from seeking immediate care that they desperately need. One of them states that BCBS simply seeks “to increase [its] profits … at the expense of everyday Texans and their medical providers.”

Insurance officials reject that claim. They say the initiative is necessary to combat purposeful overbilling and to discourage patients from thoughtlessly seeking expensive and excessive care.

Smooth sailing hardly seems likely for the BCBS program. State officials delayed its launch multiple times, and its implementation now occurs in the midst of continuing controversy.

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