BlueCross decision: Network ‘S’ out at local hospital

BlueCross decision: Network ‘S’ out at local hospital

By KEVIN BOWDEN
Staff Reporter
An agreement between BlueCross of Tennessee and Methodist Le Bonheur Healthcare means beginning Jan. 1, 2013, Baptist Memorial Hospitals in Union City and Huntingdon will no longer be in BlueCross’ Select Network (Network S).
What that means for those covered under the Network S is health claims at the two hospitals will not be covered under “in-network” rates, according to a BlueCross news release issued earlier this week.
Basically, those who are covered by Network S can stay with that coverage but will have to use another hospital other than Baptist Memorial Hospital-Union City, or they can switch to another plan that would allow them to remain “in-network” with the local hospital.
“Earlier this year, BlueCross set a goal to forge a long-term partnership with a health system in the Memphis area to drive innovation and quality in patient care, while delivering excellent value for our members in our Network ‘S.’ We had discussions with every major health system in the Memphis area as a potential partner for this strategic relationship, including Baptist Memorial Health Care (Baptist),” the BlueCross news release states. “After an extensive review, that included Baptist, we reached an agreement to move forward with Methodist Le Bonheur Healthcare (Methodist) as our new partner for Network ‘S’ effective January 1, 2013.”
That decision means BlueCross will remove Baptist from its Network S and the Baptist hospitals in Union City and Huntingdon will no longer be covered under that plan but will be covered under a Network P (Priority Network).
Letters from BlueCross to group administrators and those covered under Network S were scheduled to be mailed out this week explaining the network change.
The change in networks only affects those covered under BlueCross’ Network S.
“Baptist Hospitals will continue as valued participants in our larger Network ‘P’ and provide excellent care to our members who choose that network,” the BlueCross release states.
“Though we hoped that wouldn’t be the case, all Baptist facilities will be impacted. We regret this may result in hardships for some of our members in those areas,” the release states. “BlueCross prefers that Baptist Memorial Hospital Union City and Baptist Memorial Hospital Huntingdon remain in Network S and we are in discussions with them about this issue.”
Both health care organizations continue to “hold discussions about the issue,” according to the news release. “Per our existing contract, BlueCross has initiated the process to enter arbitration with a third party to resolve this disagreement.”
The letter from BlueCross is being sent by Henry Smith, senior vice president-operations and chief marketing officer.
“As a BlueCross member, you have the freedom to visit the hospital or doctor of your choice,” his letter states in part. “Using an in-network doctor or hospital ensures you get the most from your benefits. We still have an excellent network of hospitals in West Tennessee to provide you with quality, affordable health care. To find a Network ‘S’ provider in your area visit bcbst.com and use our ‘Find a Doctor’ tool.”
According to BlueCross, those covered under Network S will continue to have access to The Regional Medical Center (The Med) and St. Francis facilities in Memphis.
Mary Nita Bondurant is senior vice president of life and health for Union City Insurance Agency, the county’s largest insurance agency. She said her office has been flooded with calls in recent weeks as the conflict has played out between Baptist Memorial Health Care and BlueCross of Tennessee.
“I think it is important for our Medicare population to know that if they have a BCBST Medicare Supplement, they are not affected by this network issue,” Mrs. Bondurant said. “The BCBST Medicare Supplement does not use a network. When a person is on Medicare and has a Medicare Supplement, as long as they are seeing a provider that accepts Medicare, the supplement will pay as it is designed to. There is no network issue. So, in other words, anyone over 65 who is on Medicare and has a BCBST supplement can continue to go to Baptist hospitals, both in Union City and Memphis, after the first of the year.”
Both sides in the issue have already placed full-page ads in The Messenger explaining their position.

Published in The Messenger 11.30.12

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