Managed Care Contract Negotiations
Aug 06

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

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 Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →