ABILENE, TX- "We felt like this year we were left with no choice but just to cancel the contract with Blue Cross Blue Shield", said President and CEO of Hendrick Medical Center Tim Lancaster. Currently 10 percent of Hendrick's patients, which is about 10,000 households, are insured by Blue Cross.
"If we haven't come to an agreement, than as of July one, we will not be able to treat Blue Cross Blue Shield patients for an elective procedure or admission", said Lancaster.
The reason for the potential change, medical rates. In a release from Blue Cross Blue Shield, it says, quote, Hendrick is demanding a 40 percent increase to the rates we currently pay for the same amount and quality of services that they provide right now." KXVA spoke with the Chief Medical Officer for Blue Cross and he said they simply can't agree to the desired increase.
"If we were to give Hendrick the additional amount they are demanding, it would add millions of dollars annually to the cost of our members", said Dr. McCoy with Blue Cross. If a patient is mid-treatment during the possible change, Dr.McCoy says there are exceptions. "Our goal is to provide a smooth transition if possible, if people are able to change care to an in-network facility, but we have systems in place to transfer these patients to another facility or we can approve them to stay with their current hospital."
If an agreement is not made in the in the next 41 days, Blue Cross members will pay most of the cost of the treatment they receive at Hendrick but until than no changes will be made. If you have concerns about your plan or health treatment Hendrick asks that you call this number (325)-307-0368 or you can visit their website www.ehendrick.org/bcbs.
Below is list of possible solutions for any issues you may encounter if Blue Cross is no longer in-network. These facts were provided to KXVA by Louis Adams, the Director of Media and Public Relations for Blue Cross Blue Shield of Texas.I understand that BCBSTX members with certain health conditions may be able to continue their care with Hendrick and have their benefits paid at the in-network level. How do I know if this might apply to me? If it does, what do I need to do to ensure I can continue to receive care through Hendrick at the in-network benefit level? This is referring to “continuity of care.” For certain health conditions, a member may be able to continue to get treatment through a Hendrick hospital or facility and have their claims paid at the in-network level of benefits. Some examples of circumstances that may be eligible for continuity of care include a member receiving treatment for a disability, an acute condition, or life-threatening illness, or a member who is past the 24th week of pregnancy. It is important to note that benefits for continuity of care are applied according to your specific benefit plan. In addition, members who are eligible for continuity of care will not be “balance billed” or responsible to pay more than the amount covered by their plan, even if Hendrick charges more, because benefits are paid at the in-network rate. BCBSTX has established a process to work with you and your doctor to determine eligibility for continuity of care in the event Hendrick hospitals and facilities are no longer part of the BCBSTX network after June 30, 2014. If you think you may be eligible for continuity of care benefits, you should contact Customer Service at the number on the back of your member ID card. (Your doctor may also initiate this process by calling the pre-notify/pre-authorization number on the back of your member ID card.) Customer advocates will be able to help answer questions about your specific benefits and provide guidance in requesting continuity of care. Customer Service can give you a Transition of Care form, which should be completed and submitted to the fax number included on the form. Once received, the information will be reviewed. You and/or your doctor may be contacted for additional information, including medical records. A decision will be made and shared with you or your doctor, typically in less than a week. Members with questions about this process should call Customer Service at the number on the back of the member ID card. I have a procedure scheduled for next week. What do I do? You can continue to access care with Hendrick through June 30, 2014, or if you are in the Traditional/Par Plan network, through August 4, 2014. We know that having a medical procedure can be stressful, so you shouldn’t have to worry about this contract negotiation. It is important for you to know that nothing has changed for our members at this time. If you have a procedure scheduled at a Hendrick facility on or after July 1, 2014, or if you are in the Traditional/Par Plan network, on or after August 5, 2014, please contact Customer Service at the number on your member ID card to determine your benefit coverage. If you have a procedure performed prior to July 1, 2014 for PPO/POS members, or August 5, 2014 for Traditional/Par Plan members, and your hospital stay continues past the contract end dates, your care will be covered at the in-network level. We will work closely with Hendrick to avoid any issues with your hospital charges. You just focus on getting better.
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