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Lexington Medical, Blue Cross Blue Shield Battle … People Are Freaking




|| By FITSNEWS || Lexington Medical Center (LMC) will not be part of health insurance provider BlueCross BlueShield (BCBS)’s Preferred Blue network as of March 1, 2015.  Patients received letters this week and are already reportedly “frantic” – canceling future appointments and scrambling to either change physicians or find a plan that includes the popular regional hospital.

“People are upset they are losing their family doctor,” one LMC physician told FITS. “And we’re upset because this is our biggest insurance pool.”

What happened?

According to a letter sent by BlueCross BlueShield to its customers, the hospital is “demanding excessive fee increases that are much higher than fair market value, national medical inflation and the rates that other hospitals and doctors request.”

Hmmm …

The provider also ripped the hospital for allegedly not going along with its efforts to “pay providers based on the quality of care that they provide, not just how many services they perform.”

Wow.  Fighting words … although one national health care expert seemed to agree with the basic premise.

“Hospitals prefer to get paid on the old system whereas payment models are innovating to pay based on quality not quantity,” the expert told us.

Still, LMC doctors tell FITS they are optimistic everything will get sorted.

“We assume at the last minute a new contract will be reached,” one told us.

That message was reiterated in a statement issued by hospital president and CEO Mike Biediger.

“Lexington Medical Center hopes to continue negotiating with BlueCross BlueShield before the March 1 deadline,” Biediger said. “We hope that we can reach a mutually beneficial agreement to care for the patients we serve.”

The hospital’s statement expressed “disappointment” and “surprise” at the BlueCross BlueShield letter, and added that “contrary to statements from BlueCross BlueShield, Lexington Medical Center has been working to negotiate fair and reasonable terms with the insurance provider for months, offering proposals that are in line with previous agreements and that will allow the hospital to continue providing excellent health care to the people of our community.”

LMC further stated that it was “still in active discussions with (BCBS) about the contract” at the time the letter was sent.

“In fact, the hospital thought it was very close to reaching an agreement,” the hospital statement read.

“The substance of BlueCross BlueShield’s letter to members and employers has unnecessarily concerned members of the community, creating undue alarm and confusion,” the statement continued.

By the way … who’s going to give us a medal for not reflexively blaming all of this on Obamacare?  Obviously, it is to blame … but we made it all the way to the end of the article without throwing that stone.