New Policy Refuses to Pay Bills For Patients Diagnosed with Non-emergency Condition
If you have been injured in a car accident in Fort Worth, how do you know whether your serious symptoms are a true “medical emergency?” You don’t. Only a doctor can know that,
That’s precisely the problem with the latest trend in health insurance that will deny payment of emergency room bills if the insurance company arbitrarily decides that your visit was not necessary.
Effective on July 1st, this new rule was started by two of the largest companies, Blue Cross and Blue Shield and Anthem, in three states.
You’ll get stuck with a huge bill from the hospital, ER, radiologist, specialists, and ambulance. After many car crashes, these charges can quickly add up to well over $10,000.00.
This unbelievable policy forces patients to immediately and correctly diagnose their injuries as they sit in their cars dazed or lie on the side of the road after a car wreck. They will have to weigh the risks of going to the emergency room versus waiting-and-hoping for the best. The repercussions of getting it wrong are enormous. What if they are have a broken bone, herniated disc, or brain bleed and don’t know it?
This is a serious problem for the victims of automobile wrecks — and for every one else.
You know that since this new policy will save the health insurance companies a ton of money, the other companies will adopt this infuriating idea and take it nationwide.
It’s Just a Matter of Time Before This Policy Hits Texans
As Dr. Becky Parker, the president of the American College of Emergency Physicians, explained:
“The insurance company is not here to take care of people. They are here to make money. Our concern is that the insurance industry is trying to push this nationally.”
Your condition could easily worsen and cause irreparable damage if you don’t get the emergency care you need right away. However, if you go and your visit is deemed unnecessary by someone sitting in a cubicle, you will owe thousands in medical bills and your credit will be harmed.
The dilemma is even worse if your teen’s health is at stake. This ridiculous scheme excludes patients 13 and younger, but you would have to decide whether your 14 year-old child was sick enough to go to the emergency room. No parent should be placed in this terrible position.
Medical experts conclude this is a bad idea
An illuminating article published in the leading medical journal JAMA explored the policy of denying payment if the patient’s emergency room discharge reflected a non-emergency condition.
Researchers determined that “the limited concordance between presenting complaints and ED discharge diagnoses suggests that these discharge diagnoses are unable to accurately identify non-emergency ED visits.”
In other words, the patient may have made the right decision to rush to the ER even if he actually wasn’t as ill or injured as he thought. According to this study, he would have no way of knowing that his symptoms were not a serious medical emergency until a doctor properly diagnosed him. A patient who made a smart choice would nonetheless be punished if he turns out to be okay.
Like Russian roulette, a patient has no way of knowing what will happen until he pulls the trigger. But even the good news is bad news.
Patients will be denied basic health care under this cost saving measure
During my almost four decades of auto accident practice, I have often seen severely injured clients who initially thought they were okay because their symptoms were not that bad.
For example, a concussion can present as merely a very mild headache, but could result in permanent brain damages if undiagnosed — particularly if the patient doesn’t take precautions to avoid another head injury. Internal organ damage may be virtually undetectable at first, and yet could deteriorate into a health crises if left untreated.
My concern is that this new policy will have a chilling effect on patients who require immediate medical attention. As it stands, the insurance company can wash its hands of it with the self-serving explanation that he should have gone to the hospital, knowing good and well why he didn’t.
A personal injury lawyer will be able to argue to your health insurance company that your ambulance ride to the emergency room and the medical treatment you received there was reasonable and try to force the company pay its part of the bill. This is important because usually a large part of the balance is written off after this happens, saving you a lot of money.
And the car wreck lawyer will use those bills to make the other driver’s liability insurance company, or a jury, pay you back for your medical bills, lost wages, pain and suffering, and other damages you have suffered.
I urge our state legislature or national congress to make this cost saving measure illegal or at the very least, reel it in. Denying injured people and sick patients emergency care is a terrible way to save these gargantuan insurance companies money.