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Why don’t emergency room doctors at NHRMC take BCBS insurance?

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ER physicians at New Hanover Regional Medical Center are provided by an outside contractor.

Emergency room doctors are not employed by New Hanover Regional Medical Center, but through contractor Eastern Carolina Emergency Physicians, said Erin Balzotti, a hospital spokeswoman.

Eastern Carolina Emergency Physicians Administrator Dale Key said the answer is simple.

Blue Cross Blue Shield and the group haven’t been able to come up with an appropriate fee schedule, and that’s really all there is to it,” Key said.

But that doesn’t mean the hospital won’t take your insurance and bill your provider – it just means there isn’t a written agreement about reimbursements, Key said.

If a balance remains after the insurance is billed, a patient will be sent a bill for the remainder that they must pay, he said.

The group accepts Medicare and Medicaid, as well as preferred provider MedCost, he said.

United Healthcare also is not accepted at the emergency room.

Key said the group periodically negotiates with insurers about coverage.

“We’ve had discussions with them on and off periodically,” he said.

User-contributed question by:
Marty Umbaugh

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6 Responses to “ Why don’t emergency room doctors at NHRMC take BCBS insurance?”

  1. On June 30, 2011 at 4:05 pm Beth wrote:

    ER doctors not taking BCBS. I do understand their reasoning even though in my opinion, it is ridiculous. I unfortunately had to visit the ER in January and noticed the “we accept BCBS” sign in the waiting area, so I think they accept BCBS, right. I received a bill in full for the doctors visit. There was no signage, no person informing me that if I see a doctor he/she does not accept my insurance. This really got me boiling. A trap if you ask me. What other choice do you have? I was told by ECEP that I should have asked. Now, most of the time if you are in the ER your not really in the right state of mind to ask every one you see if they accept you insurance. ECEP as well as NHRM needs to come up with a system to inform all patients about this.
    thanks,
    B

  2. On June 30, 2011 at 5:53 pm NEPender wrote:

    One of the reason I prefer NOT to go to NHRMC. I’d rather go to Onslow anyways.

    Yes it is a trap. BCBS is one of the most widely accepted insurances there is. But ECEP DOES accept MEDICAID and MEDICARE…of course they accept that, that’s the government and then they can bill them at much higher rates than BCBS and other insurance providers would allow.

    There should be signage required in the waiting areas and on the paperwork you sign at check in stating that ECEP is a “contractor” of NHRMC and operates as their own entity, and the hospital is a separate entity in its own.

    The last time I took my kid to the ER for an extremely high fever, he NEVER saw a doctor, only the nurse and yet ECEP still billed for 300.00. I wish I could never see a customer and bill them 300.00 for something I never did.

    Perhaps NHRMC should look into changing “contractors” or forcing ECEP to accept BCBS if they want to provide services at the hospital…but it will never happen. That is part of the reason the medical care in this country is in the shape it is in….

  3. On July 5, 2011 at 11:06 am Steve Hill wrote:

    I fell into this same trap in 2010. When I questioned it, I was told “I should have asked”. I had to go back to the ER last month (June 2011) and was ready for them this time. I requested a BCBS doctor and was told “You’ll have to take whatever doctors are here”. When I saw the doctor I asked him if he honored BCBS. He wasn’t aware that ECEP didn’t honor BCBS especially since BCBS was their group insurance. Bottom line, it didn’t matter that I asked, I still had to pay the non-preferred pricing. The only leverage we have is to take our ER business elsewhere when we have a choice. It’s all about the money.

  4. On July 6, 2011 at 9:58 am Victoria wrote:

    I have had both BCBS and United Healthcare insurance and been to the ER at New Hanover Regional Medical Center and Cape Fear and my insurance has paid every visit. The hospital is a provider/contracted with United Healthcare and BCBS so the visit was covered.

  5. On July 13, 2011 at 7:34 am Aaron wrote:

    The entire NHRMC group is a money trap! All of the higher-paid, non-management employees are actually contractors. We just had a child and got bills from a contractor for $259.00 for a NP to look at our child ONCE and sign the discharge form. All of this should be included in the $6600.00 per night base price that NHRMC charges insurance! I can’t wait for Brunswick County’s hospital to open to give them a run for their money!

  6. On August 30, 2011 at 2:14 pm Andrew M. Terzian, M.D. wrote:

    Dear MyReporter.com

    Thank you for allowing Eastern Carolina Emergency Physicians (ECEP) the opportunity to clear up any misconception about our group’s acceptance of Blue Cross Blue Shield (BCBS) insurance. We have been providing emergency medical care for over 30 years at New Hanover Regional Medical Center and, as members of this community who have a vested interest in the health of its’ citizens, we understand that access to the best Emergency Care is vitally important. We are concerned that anyone would perceive a barrier to the care we offer.

    While it is correct that ECEP does not have a contract with BCBS insurance, it is not correct that we do not accept BCBS. For any patient covered by BCBS, charges associated with the patient’s visit are filed with the insurance information provided during the Emergency Department visit. Whether or not any emergency medicine provider is contracted with BCBS (or any other private insurer), the patient is always responsible for their regular copayment and/or deductible but nothing more in an “emergency” situation. In fact, if a private insurer denies claims for what a reasonable non-medically-trained person could perceive as an “emergency”, then the patient has protection under the Prudent Layperson Law to recover the cost of those denied claims.

    The issue presented in the Wilmington Star-News, to the best of our understanding, is apparently related to one specific and fairly uncommon type of BCBS plan that handles the payment of claims in a manner differently than most BCBS plans. Unfortunately, we are unable to explain their reasoning in regards to the Prudent Layperson Law for handling patient claims differently under this one plan.

    Again, thank you for allowing us the opportunity to clear up any misconception about our group’s acceptance of BCBS insurance. We look forward to continuing to provide our community with excellent medical care and overall service.

    For further inquiries or questions our contact information can be found on our website: http://www.ECEPNET.com.

    Sincerely,

    Andrew M. Terzian, MD
    President, Eastern Carolina Emergency Physicians



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