BCBS of Texas delays controversial ER policy: 6 things to know

Blue Cross Blue Shield of Texas will delay implementing a controversial emergency room policy for 60 days as pushback and questions mount, according to the Houston Chronicle.

Here are six things to know:

1. BCBS's discretionary ER policy, which was set to roll out June 4, will step up scrutiny of out-of-network ER claims. The insurer will deny any claims it determines after-the-fact to be nonemergent. In other words, if it isn't a true emergency, they will not pay for it.

2. The controversial ER policy has received a lot of pushback from physicians, providers and state insurance regulators who have voiced concerns that the program could negatively affect patients.  

3. Texas Insurance Commissioner Kent Sullivan and BCBS President Dan McCoy, MD, met May 29 to discuss the rollout of the policy. In this meeting Dr. Sullivan agreed to the delay.

4. On May 31, the Texas Department of Insurance sent a two-page letter to BCBS outlining specific questions the insurer must address before implementing the program. Some of the questions include how the insurer will retroactively review a patient's decision to go to the ER and what kind of appeal process would be available to patients and providers if a claim is denied. "This is a situation where the devil is in the details," an Insurance Department spokesperson told the Houston Chronicle.

5. BCBS released a statement saying it was pleased to work with the Texas Insurance Department in the next 60 days to clarify any information.  "During this time BCBS-TX will provide any further information TDI or Commissioner Sullivan requests while continuing to educate our members on the importance of appropriately using emergency services," a BCBS statement read.

6. The ED insurance policy now is slated to go into effect Aug. 6.

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