A recent article posits that an Anthem company, Blue Cross and Blue Shield of Georgia (BCBSGA), is poised to “punish” its members for “unnecessary” emergency room (ER) visits by charging subscribers the entire bill for unnecessary ER visits. This is a variation on a theme which has been playing out in virtually every state and every insurer: how do we reduce the number of unnecessary emergency room visits?
Of course, expecting a lay person to be able to parse out what is medically necessary for ER care and what is not is probably expecting too much. Example: I’m playing softball, slide into third base (at my advanced age), and jam my leg. I’m not sure if it is a bruise, sprain, tear, or a break. But it hurts like hell. It’s 7:30 PM on a Tuesday. What are my options?
Option A: I could limp home, medicate with ibuprofen and a few beers, and hope it gets better. When it does not, or next morning when I awake and am unable to ambulate out of my bed, what do I do then? But of course, the pain might subside over a few days also. My mom’s healthcare advice of wait and see might work.
Option B: Call my primary care physician (PCP), who is closed for the day with a message that “if this is a medical emergency, dial 911.” That’s helpful.
Option C: Seek a free standing urgi-center and go there. They likely will order x-rays, etc. Is BCBSGA saying you can’t go there? Unclear.