Oct. 3 post from Redmond Regional Medical Center:
“Caring for our community is a privilege and we are pleased to be able to continue to do so as part of the Anthem BCBS GA network. Our contract with Anthem has been renewed with an effective date of 10/1/2018 so that Anthem patients can continue to choose Redmond Regional Medical Center.”
Oct. 3 post from Cartersville Medical Center:
“Caring for our community is a privilege and we are pleased to be able to continue to do so as part of the Anthem BCBS GA network. Our contract with Anthem has been renewed with an effective date of 10/1/2018 so that Anthem patients can continue to choose Cartersville Medical Center.”
We’ll have additional updates later today.
PREVIOUSLY, FROM SEPT. 24
By Natalie Simms
Unless an agreement can be reached in the next seven days, Hospital Corporation of America facilities and physicians — including Redmond Regional Medical Center and Cartersville Medical Center — will be out of network for thousands of Anthem Blue Cross Blue Shield of Georgia members in the state.
The current three-year contract between HCA and Anthem expires Sunday, Sept. 30. That means that as of Oct. 1, HCA facilities and physicians will be out-of-network and customers will have to pay more for services there, unless an agreement is reached.
“Our number one priority during these negotiations is to ensure consumers have access to quality health care that is affordable. We continue to actively negotiate with Hospital Corporation of America to reach an agreement that will retain them in our care provider network beyond Sept. 30,” says Colin Manning with Anthem.
Representatives from Redmond Regional and Cartersville Medical Center both gave the same corporate response to the situation and offered no further comment:
“The normal end of term for our three-year contract with Anthem Blue Cross & Blue Shield of Georgia is Sept. 30, 2018. We are actively working with Anthem on a new agreement to ensure there will be no lapse in our partnership because we know that access to Redmond Regional Medical Center/Cartersville Medical Center physicians and care team is in the best interest of our community.”
Anthem has notified its members of the situation and set up a webpage with details and frequently asked questions.
“BCBSGa and HCA have a long history of partnership and we recognize the importance of this hospital to you and your family. That’s why we work hard to negotiate contracts that offer you a broad network of providers who agree to charge you lower rates and provide services that benefit you, our member,” states the webpage.
Under the section titled “Why is this Happening?”, Anthem puts the blame on HCA demanding higher increases than other facilities. It states:
“A health plan is nothing without skilled doctors, nurses and facilities to care for you and your family. These are critical partnerships we can’t do without. But it’s also part of our job to help manage rising health care costs. One study shows the average cost of health care for a typical family of four was nearly $27,000 in 2017, compared to $14,500 in 2007.
“Another important piece is partnering with thousands of doctors, hospitals and specialists across the country on what they will be paid for each and every health care service. Remember, the money we pay to hospitals and doctors comes directly from your monthly payments. The more we pay as a health plan, the more we all pay as members.
“Sometimes certain facilities ask for significant increases, much more than others. At Blue Cross and Blue Shield of Georgia, we believe in rewarding hospitals with reasonable increases – earned by delivering performance and quality. And most of the hospitals we work with are comfortable with that. But HCA is asking for more than similar hospitals in the area.”
What happens on Oct. 1 if no agreement is reached?
Anthem reminds its members that they are covered by one of the largest health insurers in Georgia. “We are here for you, along with many high-quality providers in and around Georgia. You can find other providers in your plan online or by calling the Member Services number on your ID card.”
The website also states that if members are having a true emergency, they will have coverage at any hospital, just get to the nearest one. And if patients are in the middle of treatment with an HCA facility or physician, they may not have to switch but be able to work out a continuum of care plan.
This isn’t the first-time hospitals and insurance companies have not been able to reach contract agreements. This past April, the contract negotiations between Anthem and Piedmont Hospital System in Atlanta was in the headlines. Ultimately, Gov. Nathan Deal had to step-in to get both parties to reach an agreement.
Local health insurance agent Jeff Osborn, with Harry Daniel Insurance in Cartersville says we might see the same thing happen in this situation.
“Insurance companies are trying to keep costs down and hospitals are trying to get more money for their services, which ultimately all comes back in higher premium costs for consumers. It is hard to jump on either side,” says Osborn.
“I think ultimately we will see something workout, it may be in October but I would be really shocked if we don’t see something work out soon. In fact, with HCA being as big as they are, we may see the governor get involved like he did with Piedmont situation earlier this year.”
But until an agreement is in place, Anthem is urging its members to reach out to their doctor or hospital to share their concerns. “Our hope is that we will be able to keep them in your plan – and also keep your health care costs affordable,” states their website.
For more information about possible impact to specific plans, click here: https://www.bcbsga.com/hca/