Emergency room physicians in Mississippi are concerned about how Blue Cross and Blue Shield will reimburse for their ER services. MPB's Jasmine Ellis reports there's confusion over a proposed policy change.
Blue Cross and Blue Shield of Mississippi is the largest private insurance provider in the state. Last month the company sent out a notice to network providers about the level of care being billed for emergency room visits starting in 2019. Blue Cross says they will evaluate and monitor ER visits to ensure they align with the severity of the diagnosis code submitted.
The Mississippi Chapter of the American College of Emergency Physicians is concerned that the insurance provider will pay based on the diagnosis and not the full amount of care the visit requires. Dr. Jonathan Jones is an emergency physician in Jackson and on the board of directors for the organization.
“You go in with chest pain or abdominal pain or the worst headache of your life, you expect a pretty big decent workup,” said Jones. “You expect x-rays or whatever is needed for your emergency. Effectively what they’re saying is that if the diagnosis ends up being something benign, you know, that wasn’t necessary. And so they’re not going to pay for it.”
Mississippi Insurance Commissioner Mike Chaney says his office has received some complaints about patients being overcharged and believes this policy update benefits consumers.
“Contrary to what the emergency room physicians are saying, Blue Cross put a letter out that said that they were not denying payment,” said Chaney. “They were just looking at the upgrade and whatever the diagnostic was and whether or not it was justified.”
In a statement Meredith Bailess with Blue Cross says in emergency situations members should always "seek care at the nearest healthcare facility and trust their care will be covered." And that they will continue working to ensure the cost of emergency care is managed appropriately.