Hospital's lack of contract renewal with insurers unknowingly puts patients out of network

[eridani]

Georgia Health News
http://www.georgiahealthnews.com/2014/11/grady-blue-cross-impasse-contract-expires/

Contract standoffs between hospital systems and health insurers typically have a way of being resolved — often right before a deadline.

But high-stakes negotiations between Grady Health System and Georgia’s biggest insurer failed to produce a new contract before the midnight deadline Sunday.

That means Grady Memorial Hospital is now “out of network” for Blue Cross and Blue Shield of Georgia members. Patients with Blue Cross insurance will face higher out-of-pocket costs at the Atlanta hospital and its clinics.

Lindsay Caulfield, senior vice president of public affairs at Grady, said in a statement Monday that Blue Cross “pays our health system up to 70 percent less than it pays other Georgia hospitals. By paying us unfairly low rates, Blue Cross Blue Shield has long put Grady at a disadvantage and threatens our long-term sustainability.”

Grady proposed several compromise plans, Caulfield said, “but Blue Cross continually refused to move in their position in any meaningful way.”

The lack of an agreement will affect Blue Cross in trauma services, where Grady has a strong profile, Smith said. But he added that he believes the two sides will eventually reach a new deal. “It’s going to be very difficult for any hospital not to have the largest payer in the state,’’ he said.

Comment by Don McCanne of PNHP: We’ve heard similar stories many times before. The largest insurer in Georgia, WellPoint’s Blue Cross and Blue Shield of Georgia, has been unable or unwilling to negotiate a contract renewal with Grady Memorial Hospital, the home of one of the most prominent trauma centers in the nation.

Although Grady will continue to provide emergency services, it is the patients who will be exposed to excessive costs, only because we have a system in which we insist that private, for-profit, autonomous corporations be allowed to take charge of our health care dollars.

The solution is obvious - fire WellPoint and the other private insurers and replace them with our own single payer national health program - an improved Medicare that covers everyone.

[ecstatic]

1. This is not cool. I don't know anyone insured who would

purposely go to Grady, but as the article notes, Grady has a great trauma center and it's central Atlanta location makes it a likely destination in the event of a major accident where the victim isn't able to tell EMTs where s/he wishes to be taken. So basically someone who tried to be responsible and do "everything right" could still end up screwed.

[eridani]

2. Exactly. I'm pretty sure that everyone on DU realizes--

--that there is no such thing as a "provider network" in the rest of the developed world.

[Brigid]

3. I shall now sing the song of my people:

Single Payer Now.

[Hoyt]

4. Lots of times its the hospitals or docs who are greedy ones, demanding more money

and willing to put patients at risk.