Negotiations to keep Piedmont Healthcare in Blue Cross Blue Shield of Georgia's insurance network have gotten grim, and the deadline is midnight Saturday.
The negotiations affect perhaps a half-million patients in the state, and they’re starting to feel the heat. A major group of customers got new insurance cards in the mail from Blue Cross in recent days in anticipation of contract failure, with their doctor’s name replaced. And more than 100 lawmakers received a letter Thursday from Piedmont suggesting that Blue Cross intended to end the contract.
“I feel like I’m kind of being crushed on two sides,” said Dina Canup, an Athens resident who works in student outreach at the University of Georgia and received one of the new cards this weekend.
The negotiations between the two companies have gone down to the wire perhaps a half-dozen times in years past, a spokesman for the state Department of Insurance said.
This year's negotiations contain matters of particular tension. Piedmont has sued Blue Cross and its parent company, Anthem Inc., over the insurer's decision to no longer pay for some in-hospital MRIs and for emergency room visits it determines were not warranted.
Canup was planning to join a rally on the issue Thursday evening in Athens demanding that the companies come to resolution and that they loop in patients. She wasn’t the only one headed there. The University System of Georgia and the state employees’ health plan both use Blue Cross as a major option, and the new cards seem to have gone to university HMO patients in the Athens area. They’ve been a shock to workers, said Annelie Klein, a leader in the university workers’ union there.
Klein, who works at the College of Pharmacy, has just gotten a new audiologist and gastroenterologist. They will be out of network if the contract doesn’t go through, and she said her doctor already quoted her a higher-than-normal co-pay, causing her to cancel an appointment.
The stakes are higher for Canup, whose 8-year-old daughter is autistic and craves the familiar.
“To get new cards out of the blue, and they pre-emptively select a new doctor for me, is just stunning and outrageous,” she said.
When her daughter’s anxiety spikes and she gets sick, she doesn’t drink and becomes dangerously dehydrated, Canup said.
She’s been hospitalized at Piedmont Athens Regional Hospital three times in the past year, and her familiarity with the facility helps manage her anxiety, her mother said. She cares where they park. And the pediatrician she has had since birth was the first to detect signs of autism.
“This doctor is one of the most important people in her life,” Canup said.
Perhaps a half-million Georgians have used a Piedmont service with Blue Cross insurance in the past 18 months, said Matt Gove, a spokesman for the health system. If the contract is not renewed by midnight Saturday, on Sunday the contract will be over and the patients will pay out-of-network prices if they want to stay with those providers.
Blue Cross has sent letters to its customers warning them of the impending deadline and saying it has continued to negotiate. Insurers say the letters are required, while hospitals say they’re used as negotiating tactics.
Following complaints about the new cards, Piedmont’s vice president for government and external affairs, Tom Worthy, wrote legislators whose districts contain Piedmont caregivers saying the situation looked bad. “Our managed care team has been working literally around-the-clock to try to reach an agreement,” Worthy wrote, “but unfortunately, we now believe BCBSGa plans to take Piedmont out of its network.”
Worthy said in the letter that he was writing because lawmakers had asked him about the negotiations. He claimed Blue Cross had issued the new cards without informing the University System, physicians or patients.
“BCBSGa took away patient choice and inserted itself into the highly-personal relationship between patient and physician as a negotiation tactic,” he wrote, saying Blue Cross was using patients as a negotiating tool. “If BCBSGa takes us out of network as Anthem has done to other health systems around the country, we will be coming to you next year with legislative proposals to address this reckless display of brinksmanship and prevent it from being done in Georgia in the future.”
Blue Cross told the AJC that it was “continuing to negotiate in good faith to reach an agreement that would enable Piedmont to remain part of Blue Cross and Blue Shield of Georgia’s care provider network.” As to the cards, the insurer said, “It is important that we help ensure our consumers have uninterrupted access to affordable healthcare, which includes identifying and assigning consumers an available health care provider that matches with their needs and will be in-network after March 31.”
State Senate Majority Leader Bill Cowsert, a Republican who represents Athens, said he didn’t know enough to say who was to blame. But he received Piedmont’s letter on the hectic final day of the legislative session and heard from his constituents who got the new Blue Cross cards, and said he was “very disappointed.”
“I hope things are worked out to the satisfaction of everybody, but primarily to the satisfaction of the citizens,” Cowsert said. “And I hope that both Piedmont and Blue Cross will remember that they’re in the business of serving patients and insuring patients” as opposed to just making a profit.
The two companies each have a website for patients to get answers, bcbsga.com/piedmont and keeppiedmont.org.
NEW DETAILS
Previously: Negotiations to keep Piedmont Healthcare in the Blue Cross Blue Shield network have become particularly tense this year.
The latest: Some customers have received new insurance cards replacing their doctor's name.
What's next: The contract expires at midnight Saturday.
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