Miss ER worries the change of insurance policy


A group of doctors is worried about a planned policy change in the Blue Cross and Blue Shield of Mississippi, which he says could lead to a reduction in the care provided when a patient presents himself or herself to the patient. emergency room.

The Mississippi section of the American College of Emergency Physicians said it is concerned with a change according to which the insurer will review the emergency bills so that the "level of care" charges match more closely to the patient's diagnosis and not to his symptoms.

The group is concerned that the policy – which should come into force next year – means that testing and treatment linked to the "exclusion" process is no longer covered. However, the Mississippi Insurance Commissioner said the decision was aimed only at preventing hospitals from overcharging their bills because of the seriousness and complexity of an emergency visit.

"A patient who feels chest pain and fears a heart attack should be covered for his visit, even if it is a non-urgent medical problem, such as hiatal hernia "Emergency doctors wrote in a recently distributed letter, which was not sent to the insurance company.

More: Medical Billing in the "Land": UMMC Changes Policy Following an Investigation into an Expensive Emergency Visit

Patients expect emergency physicians "to use their medical expertise and the tools at their disposal to" eliminate "life-threatening conditions, such as a heart attack. But the new billing policy "totally ignores" these precautionary measures, he said.

The doctors added that the new policy did not follow the "industry standard" for medical billing. A federal policy called Prudent Layperson Standard guarantees insurers cover visits based on the patient's symptoms and not on the final diagnosis, they said.

In a statement, Blue Cross and Blue Shield of Mississippi said it was "committed to managing the costs of health care while ensuring that quality care is available to our members when they need it". However, the company indicated that it would not make any further comments until it had discussed the issue with the doctors in its network and that the managers had not responded to a request additional clarification of the new policy.

The insurer sent a notice to providers earlier this month in which it was announced that "visit levels would be aligned with the severity of the diagnosis" submitted by the hospital. He added that clients had expressed concerns over the past year about hospital billing for emergency room visits.

Hospitals charge for the use of emergency services that reflect the severity and complexity of the visit, ranging from Level 1 (less severe) to Level 5, which may be life-threatening and require significant testing and treatment. Emergency costs at the University of Mississippi Medical Center, for example, can range from $ 468 to almost $ 5,000 for a single visit.

More: After UMMC acknowledged that the billing for emergencies was unfair, questions about the policy change remain.

An analysis of Clarion Ledger earlier this year showed that UMM had hardly ever charged for the lowest levels of emergency visits, and that a visit to the emergency At the Batson Children's Hospital of UMM still cost at least $ 2,000 for any reason. (Batson, later, said that he would change his method to determine severity levels of visits.)

A report released last year by Vox and the Health Care Cost Institute also revealed that these facility fees had increased significantly in recent years nationwide, with a higher percentage of billed visits at levels 4 and 5.

State Insurance Commissioner Mike Chaney said last week that the Blue Cross & Blue Shield movement appeared to be aimed at stopping this "misuse of upward coding" by hospital emergencies. – a practice of charging fees for a service or level of care is higher than what the patient actually received or needed. He said that the policy change does not require the approval of the state.

"Blue Cross is trying to protect the exorbitant payments that should not be paid," Chaney said. He added that the new policy does not prohibit testing suppliers or Blue Cross from paying for certain tests.

Members of the Mississippi American College of Emergency Physicians are concerned if patients could be trapped if Blue Cross decides not to cover higher hospitality costs due to a complex emergency visit – such as a patient reporting severe chest pain – a less serious diagnosis, such as acid reflux.

"Patients who fear that their visits are not properly covered can delay seeking care and put their health at risk – and worse, their lives," the letter says.

Gregory Patino, an emergency physician and former group president, said the treatment could also unfairly penalize providers who perform meaningful tests and evaluations on a patient, but are finally able to quickly return them home because their condition health is not as serious as initially. thought.

"Why is it less helpful to be able to give good news to someone and stop them from going to the hospital (for a longer stay)?" he said.