Texas allows Blue Cross Blue Shield to deny payments for some out-of-network ER visits

Written by Reed Tinsley | August 6, 2018

Blue Cross and Blue Shield of Texas will begin a controversial new program today in which it will not pay any expenses for an out-of-network emergency room visit if it is later determined the patient should have gone elsewhere for treatment. Under the new policy, which was announced in April, a medical director hired by the insurer will review claims after the ER visit and determine the reason a patient opted for the ER and if they could have received treatment at a less expensive clinic. BCBS also will look for over-treatment.

Could this become a national trend?

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About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.

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