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Metroplex system may sever ties with BlueCross

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Posted: Friday, April 22, 2005 12:00 pm | Updated: 3:15 pm, Wed Aug 15, 2012.

By Natalie Younts

Killeen Daily Herald

The Metroplex Health System will stop accepting BlueCross BlueShield of Texas on May 15 if the two entities fail to reach a financial agreement on insurance reimbursement rates.

Killeen-based Metroplex is part of the Adventist Health System, which operates 37 hospitals in 10 states.

The Adventist Health System wants a significant double-digit increase in reimbursement rates, said Margaret Jarvis, spokeswoman for BlueCross. She said there are 9,007 BlueCross BlueShield members in Bell County.

BlueCross received a letter of termination in February from Metroplex, as well as Adventist Health System hospitals in Fort Worth and San Marcos, Jarvis said.

Some people are under the impression that we sent them a termination letter, but they sent us a termination letter, she said.

In a statement released Thursday, Ken Finch, Metroplex Health System CEO and president, said the system has a commitment to provide and expand its high quality, high-tech and efficient medical services to the community.

For this reason, Metroplex has in good faith attempted to negotiate fair and reasonable reimbursement rates from BlueCross. For the past five months, BlueCross has been non-responsive to our requests.

BlueCross has increased its fees to members over the past several years and has thereby increased its revenues; however, it has not increased reimbursements to Metroplex in three years, Finch stated.

We have given BlueCross a 90-day termination notice per their contract, he said. It is our hope that BlueCross will make a good faith effort to resolve this issue.

Dr. Robert Perry, a Metroplex family physician in Copperas Cove, said that insurance companies usually increase their reimbursement rates every three to five years.

It was time for BlueCross BlueShield to work out that contract nationally with Adventist health care system, he said. BlueCross isnt coming to the table. Theyre like, No, we dont want to talk about any rate increases.

Kempner resident Alma Jackson said her partner, Doris Bratton, uses BlueCross. Bratton has a heart condition, she said.

Were terrified. Her only option if something happens to her is to get in an ambulance and go to Austin or Waco, she said.

Bratton had pneumonia and was unable to speak. She has used BlueCross BlueShield for 40 years.

I think its theft and its outrageous to deny reasonable and timely access because somebody cant sit there at a table and work something out, Jackson said. That is the most unprofessional thing I can think of.

If an agreement cannot be reached, the insurance will no longer be accepted at midnight on May 14.

Should those three hold to their decision to terminate the contract, members would need to call the customer service number on their ID cards to locate alternative providers, Jarvis said.

Were optimistic and were going to keep the lines of communication open, she said.

Jarvis said BlueCross is very disappointed that no agreement has been made despite reasonable offers and our best efforts.

Dr. Dave Webster, a Metroplex family physician in Harker Heights, said he hopes the health system and insurance provider are able to negotiate a reasonable contract.

Reimbursements are low and motivations to renegotiate that have been somewhat lax, he said. Its very difficult to have any type of communication with those folks.

Jarvis said that if the health system and BlueCross BlueShield of Texas do sever relations, a notification will be sent to large-group employers whose employees use the insurance.

We do not send member letters unless an individual member has a pre-certification or referral in our system that is at that hospital, she said.

Webster said 10 percent of his patients use BlueCross BlueShield.

Metroplex affiliates in Copperas Cove and Lampasas will also stop taking BlueCross on May 15 if reimbursement rates are not agreed upon.

There are all these BlueCross BlueShield patients here who dont know whats going on, Perry said.

Contact Natalie Younts at nyounts@kdhnews.com

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