ATLANTA/WASHINGTON, D.C.—In response to the discontinuation of Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. (BCBSHP)'s “avoidable ER” program, which reviewed claims on behalf of its individual insured members for payment regarding emergency room services, the American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) have agreed to withdraw the lawsuit filed in July 2018 in the U.S. District Court for the Northern District of Georgia. ACEP and MAG originally brought the lawsuit against BCBSHP over concerns the insurer's program would result in violations to the federal prudent layperson standard.
According to Director of Medical Operations Anup Sharma, MD/MBA at BCBSHP, “BCBSHP instituted its ‘avoidable ER’ program in 2017 to prevent inappropriate use of the ER for non-ER care, and to encourage members to connect with their primary care providers, use telehealth, or visit urgent care for non-emergency conditions to promote a comprehensive approach to care. Since 2017, BCBSHP’s members have increasingly taken advantage of these options to obtain safe and effective care for non-emergency conditions. BCBSHP maintains that its ‘avoidable ER’ program complied with all applicable state and federal laws, including the prudent layperson standard.”
“We genuinely appreciate BCBSHP coming to the table and taking this action to address our concerns regarding BCBSHP's review of emergency room claims,” says MAG President Fred Flandry, MD, FACS, “We hope this will give patients additional peace of mind when seeking emergency room care."
“This is a mutually successful outcome of a three-year long lawsuit in Georgia,” said Gillian Schmitz, MD, FACEP president of ACEP. "We believe this is the best outcome for Georgia patients and emergency providers alike, and this decision will allow our members to focus on providing quality care and treatment to those patients who walk through their doors and to continue to save lives."
BCBSHP states that the change will go into effect on March 18, 2022.
Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. is an independent licensee of the Blue Cross Blue Shield Association. The Blue Cross Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Additional information about Blue Cross and Blue Shield of Healthcare Plan of Georgia, Inc. is available at www.bcbsga.com. Also, follow us on Twitter at www.twitter.com/@BCBSofGA_News.