• September 2, 2014

Blue Cross, Metroplex extend deal

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Posted: Saturday, May 14, 2005 12:00 pm | Updated: 3:15 pm, Wed Aug 15, 2012.

By Natalie Younts

Killeen Daily Herald

The Adventist Health System and Blue Cross and Blue Shield of Texas have not agreed on reimbursement rates, but the two did agree Friday afternoon to extend the contract between Metroplex Health System and the insurer to May 31.

The original contract would have expired tonight if the entities did not agree on reimbursement rates.

The 19,000 BCBSTX members in Bell County would have awakened on Sunday morning without medical insurance coverage for Metroplex Hospital or its affiliated doctors.

The Adventist Health Sytem requested that BCBSTX give an extension on the termination deadline until the end of the month, and the company agreed, said Margaret Jarvis, spokeswoman for Blue Cross.

This means we will have additional time to evaluate and explore options with them, she said.

Eight months ago, Metroplex began asking BCBSTX to pay higher reimbursement rates for medical procedures and services.

We do not believe Blue Cross has been responsive to our efforts, said Ken Finch, president and CEO of Metroplex, in a statement released Friday morning.

It eventually became clear that contract termination was our only option.

According to the statement, the hospital had not had a rate increase in more than three yeras, yet Blue Cross will not acknowledge that Metroplex Hospital should receive market-competitive reimbursement.

In a statement released Thursday, Ted Haynes, vice president of network management for BCBSTX, said that the company has tried to reach a reasonable agreement.

We had certainly not anticipated that reimbursement levels to the hospitals would remain static; however, we have tried to achieve a balance that would also allow us to fulfill our responsibility to our members to hold the line on medical cost increases, he said.

Blue Cross sent letters to a number of local physicians, informing them that they will be disconnected from the network unless they have admitting privileges at hospitals other than Metroplex that remain in the network.

Adventist Health System hospitals in San Marcos and Fort Worth are also involved in the negotiations.

We want to be optimistic that a settlement will be reached soon, Finch said in the statement. Face-to-face meetings have been occurring.

Before the deadline extension was announced, Amanda Allen, office manager for the Family Medicine Clinic in Copperas Cove, said that her office was planning to begin new protocol on Monday if a settlement had not been reached.

Its going to be fairly new ground on Monday, she said. Its probably going to be confusing.

She said that when a BCBSTX patient comes into the office, the staff member would call the insurer to check on the patients status.

If the insurer tells them they would not cover the patient, the patient could still be seen, but would have to pay for the services themselves.

If the patient needed to go to a hospital, or receive such services as X-rays or CT scans, the patient would have to be sent to Austin or Waco, she said.

A referral coordinator at ABC Pediatrics in Killeen, who wished to be unnamed, said her office planned to stop taking new BCBSTX patients on Monday if an agreement was not reached.

The patients we do have will have to pay out-of-network costs, she said.

She said a typical BCBSTX patient would owe a $15 co-pay, while a regular office visit costs $75 without insurance.

BCBSTX will be faced with higher insurance premiums and higher health care costs if it yields to the attempts of three hospitals to significantly increase reimbursement rates to the facilities, according to Blue Cross.

Jarvis said that the Central Texas Medical Center in San Marcos still had 2 years left on its contract, but the Adventist system terminated it early in order to gain an advantage in the negotiations.

Why were they negotiating all of these contracts at once? she asked, They were trying to gain an advantage in their negotiations in Fort Worth by using the fact that the other two facilities (in Killeen and San Marcos) were more vital to the locations they are in.

According to Metroplex, reimbursement rates from BCBSTX are significantly less than Medicare for inpatient services, 20 percent lower than other hospitals in the Austin or Waco market, and 17 percent less than the hospital in San Marcos.

Blue Cross is required to pay for emergency care at the members in-network benefit level even if the contract between the two terminates, according to Metroplex.

Jarvis said an emergency would be a condition that constitutes risking life or limb, probably including a heart attack.

Rollins Brook Community Hospital in Lampasas is also a part of the Adventist Health System.

Contact Natalie Younts at nyounts@kdhnews.com

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