Georgia’s Emergency Claims Review Program Halted by Blue Cross Blue Shield Healthcare Plan of Georgia, Inc., and CAPE and MAG Withdraw Complaint in Response

PR Newswire

ATLANTA and WASHINGTON, March 9, 2022

ATLANTE and WASHINGTON, March 9, 2022 /PRNewswire/ — In response to the discontinuation of the Blue Cross Blue Shield healthcare plan from GeorgiaInc. (BCBSHP), which reviewed claims on behalf of its individual insured members for payment for emergency room services, the American College of Emergency Physicians (ACEP), and the Medical Association of Georgia (MAG) agreed to withdraw the complaint filed in July 2018 in the United States District Court for the Northern District of Georgia. ACEP and MAG originally filed a lawsuit against BCBSHP over concerns that the insurer’s program would lead to violations of the prudent federal layman’s standard.

CAPE logo. (PRNewsFoto/American College of Emergency Physicians) (PRNewsfoto/ACEP)

According to the director of medical operations Anup SharmaMD/MBA at BCBSHP,” BCBSHP instituted its “Preventable ER” program in 2017 to prevent the inappropriate use of ER for non-ER care and to encourage members to connect with their primary care providers, to use telehealth or seek emergency care for non-emergency conditions to promote a holistic approach to care Since 2017, BCBSHP members have increasingly taken advantage of these options to obtain safe and effective care for non-emergency conditions. BCBSHP maintains that its “preventable ER” program complied with all state and federal laws, including the prudent layman standard.”

“We sincerely appreciate that BCBSHP has come to the table and taken this step to address our concerns about BCBSHP’s review of ER claims,” ​​the MAG chair said. Frederic Flandry, MD, FACS. “We hope this will give patients additional peace of mind when seeking emergency care.”

“This is a mutually successful result of a long three-year trial in Georgia,” noted Gillian Schmitz, MD, FACEP, CAPE President. “We think this is the best result for Georgia patients and emergency providers, and this decision will allow our members to focus on providing quality care and treatment to the patients who walk through their doors and continue to save lives. »

BCBSHP states that the change will be effective on March 18, 2022.

The American College of Emergency Physicians (ACEP) is the national medical society representing emergency medicine. Through continuing education, research, public education and advocacy, CAPE advances emergency care on behalf of its 40,000 member emergency physicians and the more than 150 million Americans they process every year. For more information, visit www.acep.organd www.emergencyphysicians.org.

With over 8,400 members, MAG is the leading voice for physicians in Georgia. MAG represents physicians in all specialties and practice settings. Visit www.mag.org for more information about MAG.

Blue Cross Blue Shield Health Care Plan GeorgiaInc. is an Independent Licensee of the Blue Cross Blue Shield Association. The Blue Cross Blue Shield names and symbols are registered trademarks of the Blue Cross and Blue Shield Association. Additional information on 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.

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SOURCE American College of Emergency Physicians (ACEP)

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