The Texas Medical Association has reached out to Blue Cross and Blue Shield of Texas (BCBSTX) to obtain more details on a new HMO emergency care policy at BCBSTX unveiled this week.
In a memo, BCBSTX said that beginning June 4, its fully insured group and retail HMO members may be required to pay 100 percent of their medical bill if they go to an out-of-network emergency room for certain non-life-threatening conditions.
According to the memo, BCBSTX will send letters May 1 to members who have had an out-of-network ER claim notifying them about the change. The memo also details how a claim will be reviewed, including requesting medical records and an itemized bill for the claim.
Under Texas law setting forth HMO out-of-network payment requirements for emergencies, “emergency care” is defined with a “prudent layperson” standard. This is an important patient-protection measure as patients should not be expected to have the same level of medical expertise as their physicians regarding what constitutes an emergency medical condition.
TMA is committed to ensuring that patients not be dissuaded from seeking needed emergency care in situations where they believe their health is at risk.
Last Updated On
May 01, 2018