I can’t tell you how many people sent me the article last week regarding Blue Cross and Blue Shield of Georgia stopping coverage for ED visits that they deem unnecessary. I am not sure as to all of the fuss since insurers serving their members in western Maryland have been denying payment for what they deem unnecessary care for the last several years. If BC /BS of Georgia is like our local insurers, they will do little to nothing to educate their members on when and when not to use the ED, but hold the hospital accountable for the care that it rendered to their member.
When a patient presents in the ED, we are required by law to provide care. We have been working to educate patients on when to use their physician versus urgent care versus the ED. We have had some success over the last few years, but we still have to fight denials on a continual basis. We have increased visits to urgent care while reducing the number of ED visits; but again, that responsibility has fallen to the hospital. We can’t be providing expensive emergency level care knowing that we won’t be paid.
I certainly do not begrudge insurers seeking to reduce their costs, but their solutions need to be well thought out and applied as such. Simply removing the proverbial monkey from their back and placing on the back of the hospital isn’t a viable solution.