You Gotta Pay Up Regardless of The Final Diagnosis

Relating to the definition of emergency care for purposes of certain health benefit plans…..



Not sure who is sponsoring this.  I can almost guarantee Donna Campbell will be for it.  It makes it easier for the FSER’s to claim any visit is an emergency, and therefore should be paid at ER rates.  So, the BCBS’s of the world, who are trying to retrospectively deny certain simple ER visits as being an emergency, will be thwarted in their efforts.  I can tell you in my experience that 90% of patients that present to a FSER (and maybe 70% to a hospital ER) are NOT emergencies as you and I might think of them (are they life or limb threatening?).  They are urgencies dressed up by the provider as an emergency.  It’s true some people think they are having an emergency, but the existing statute language should take care of those episodes.  So, think of a sore throat as “acute tonsillitis”, or a routine URI as “acute respiratory distress”.  And, of course they will do a CXR and/or chest CT on anyone with a cough and a fever which will substantiate/validate that the problem was severe enough to be considered an emergency.  So, the URI or ST that costs $150 – $300 in an UCC will cost $1500 – $3,000 in a FSER.  They only need to see 10 paying patients a day to break even.  Do you think this is a scam?