Looking4Ward
Full time employment: Posting here.
So I've been hammering BCBS over the last several weeks to tell me which Emergency Rooms in my area are considered "In Network". After much back-and-forth, they finally provided a list of facilities. So I then moved on to my next question, which of those facilities have ER Physicians who are in-network as well?
Here was their answer:
"Unfortunately we cannot verify if all ER physicians at these locations are in network as we do not have a listing of their ER physicians. You would need to contact the Facility directly to verify if their ER physicians are in network. We regret any inconvenience."
Evidently the burden is back on the patient to double/triple check everything, even when unconscious and being transported by EMS.
But wait - there appears to be some protection and increased movement towards a solution, at least in Texas. I found this interesting tidbit of information in regards to HMO's from the Center for Public Policy Priorities out of Austin:
"For Health Maintenance Organizations (HMOs), the Texas Department of Insurance (TDI) has long maintained that in an emergency or when an in-network provider is not reasonably available, consumers should have to pay no more for out-of-network care than they would have for in-network care. In other words, consumers are not liable for balance bills, and the HMO has the responsibility of fully reimbursing the provider. This protection on paper, however, may not always translate into practice. State law does not prohibit an out-of-network provider from sending a balance bill to a consumer enrolled in an HMO, even though the HMO should be on the hook to resolve it. HMOs must instruct consumers to call the HMO if they get bills for out-of-network services, but neither HMO disclosures nor provider bills are required to explicitly say that the HMO, not the consumer, is liable for balance bills resulting from emergency care. Due to the convoluted nature of these protections, consumers in HMOs could receive balance bills stemming from emergencies and pay them, never knowing they are not technically responsible for the bill. TDI plans to amend state HMO rules soon and will have the opportunity to make existing “hold harmless” consumer protections explicit, so that they are meaningful for consumers."
Full document here:
Surprise medical bills take advantage of Texans
Here was their answer:
"Unfortunately we cannot verify if all ER physicians at these locations are in network as we do not have a listing of their ER physicians. You would need to contact the Facility directly to verify if their ER physicians are in network. We regret any inconvenience."
Evidently the burden is back on the patient to double/triple check everything, even when unconscious and being transported by EMS.
But wait - there appears to be some protection and increased movement towards a solution, at least in Texas. I found this interesting tidbit of information in regards to HMO's from the Center for Public Policy Priorities out of Austin:
"For Health Maintenance Organizations (HMOs), the Texas Department of Insurance (TDI) has long maintained that in an emergency or when an in-network provider is not reasonably available, consumers should have to pay no more for out-of-network care than they would have for in-network care. In other words, consumers are not liable for balance bills, and the HMO has the responsibility of fully reimbursing the provider. This protection on paper, however, may not always translate into practice. State law does not prohibit an out-of-network provider from sending a balance bill to a consumer enrolled in an HMO, even though the HMO should be on the hook to resolve it. HMOs must instruct consumers to call the HMO if they get bills for out-of-network services, but neither HMO disclosures nor provider bills are required to explicitly say that the HMO, not the consumer, is liable for balance bills resulting from emergency care. Due to the convoluted nature of these protections, consumers in HMOs could receive balance bills stemming from emergencies and pay them, never knowing they are not technically responsible for the bill. TDI plans to amend state HMO rules soon and will have the opportunity to make existing “hold harmless” consumer protections explicit, so that they are meaningful for consumers."
Full document here:
Surprise medical bills take advantage of Texans
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