Insurance woes for some at YRMC ER

Going to the emergency room? Don’t be surprised if they don’t take your insurance.

What it comes down to is the cost of doing business, said Phillip Richemont, M.D., chair of the department of emergency medicine at Southwest Emergency Physicians (SWEP), the group that runs the ER at Yuma Regional Center.

Richemont said they don't contract with any carriers, but they only have a difficult time with Blue Cross Blue Shield (BCBS) of Arizona. He said they bill the same to all major carriers, in addition to Medicare and the state Medicaid program.

BCBS of Arizona spokeswoman Renee Hunt said while she couldn't give exact numbers of how many people in the Yuma area are enrolled with the carrier, they have more than 1.3 million customers statewide, and Yuma is a growing market for them.

Employers in Yuma County that contract with BCBS of Arizona include Northern Arizona University's Yuma campus, Yuma Elementary School District 1 and Freedom Communications, parent company of the Yuma Sun.

Hunt said providers they contract within the area include 90 primary care physicians and 479 specialists in Yuma County as of this month, along with five urgent care centers in Yuma.

A YRMC spokeswoman previously told the Yuma Sun that the hospital contracts with SWEP and does not control which insurance carriers the group contracts with.

YRMC physicians not in the emergency room are contracted with BCBS.

"It's sad and frustrating for us," Richemont said. "We don't want to have issues with anybody."

With 75,000 ER visits a year, the physicians see a lot of people, he said. And of that, the payments they receive back amount to less than one-third of what they bill out.

He said BCBS of Arizona wants to charge less than other insurance carriers for the same service - and if they were to contract with the carrier, they'd have to reduce staff to make up the difference.

"I'd have to fire two providers because that's what it would cost," Richemont said.

Hunt said emergency services are still available to members even if they're not contracted, and members should always keep in mind lowering out-of-pocket costs when it comes to health care.

She said if it's a non-emergency situation, definitely visit your primary care physician or an urgent care center.

In addition to a lower return on services, Richemont said, it costs more to recruit doctors to come to the Yuma area.  He said they usually have to pay physicians one and a half to two times more than normal.

Myles Riner, a managed care contracting consultant and a former clinical physician for 34 years in California, said legally, emergency rooms have to see every patient - part of the Federal Emergency Medical Treatment and Active Labor Act.

"People have to turn to the emergency room as their only option," Riner said.

In some areas such as rural areas with a higher rate of uninsured, the problem can grow.

Riner said if a health care provider offers poor rates, then they elect to not be a provider. He said it's not uncommon, though it is a little less common for an ER not to contract with anyone.

Richemont said it's frustrating. "We're being sort of held over a barrel."

Riner agreed. "Emergency physicians are kind of captive providers. It's a very awkward, difficult thing."

What that can come down to, said Laura Gore, spokeswoman for American College of Emergency Physicians, a group that represents emergency room doctors, is hospitals having to close the emergency room.
 
Richemont said they just want the same deal as the hospital and that they've held meetings to figure out what they can do.

He said they're trying to work with the community.

"We're local members of the community, we're not outsiders."