Blue Cross Blue Shield Healthcare Plan of Georgia plans to end its "avoidable emergency room" program on March 18.
The health plan instituted the avoidable ER program in 2017 to prevent inappropriate use of the ER and instead encourage members to connect with primary care or urgent care providers.
The American College of Emergency Physicians and the Medical Association of Georgia sued the health plan over the policy, arguing it would result in violations of patient protections laid out in the prudent layperson standard. As a result of BCBS revoking the policy, the two organizations withdrew the lawsuit, which was filed in 2018.
"We genuinely appreciate BCBSHP coming to the table and taking this action to address our concerns regarding BCBSHP's review of emergency room claims," said Medical Association of Georgia President Fred Flandry, MD. "We hope this will give patients additional peace of mind when seeking emergency room care."
"BCBSHP maintains that its 'avoidable ER' program complied with all applicable state and federal laws, including the prudent layperson standard," BCBS of Georgia Director of Medical Operations Anup Sharma, MD, said.