Going to the emergency room for a simple sore throat will cost Georgians who get their insurance through Blue Cross Blue Shield of Georgia as of July 1, when a new rule designed to cut unnecessary healthcare costs goes into effect. In a nutshell, it demands that patients choose another care setting unless they have a true emergency—urgent care being the most likely source, given the difficulty many find when trying to make timely appointments with their primary care physician. If they do go to the emergency room with a nonemergent complaint, BCBS won’t pay the bill. There are exceptions to the rule, such as for children 13 and under, absence of an urgent care center within 15 miles, and visits on Sundays and major holidays. BCBS of Georgia defines an emergency as any complaint that a “prudent layperson” would think could pose a serious danger. The company has the right to decide if patients chose correctly, however.
Georgia Blues Put Pressure on Patients to Choose Between Urgent Care and the ED