ED Coding and Reimbursement Alert

Question: I read your article last month about Missouri’s efforts to curb Anthem’s policy of denying non-emergent visits to the ED. We have heard that this is going to expand to other payers beyond Anthem and that our Blue Cross payer here in Texas is implementing the same program. Is this true?

Texas Subscriber

Answer: Blue Cross Blue Shield of Texas was planning to implement a shift in its policy at the beginning of June. Under the updated policy, the payer would have denied out-of-network emergency room visits if its reviewers later determined that the visit was for a non-emergent condition.

However, after a Texas Insurance Commissioner met with Blue Cross executives, a decision was made to delay the rule for eight weeks. Therefore, the rule was not put into place in June, and is now expected to go into effect in August, assuming further delays do not happen.

So although Blue Cross Blue Shield of Texas has not yet implemented a policy restricting ED visits to emergent conditions only, that policy could go into place later this summer.