HealthcareSC

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

HEALTH INSURANCE PROVIDER’S FIGHT WITH HOSPITAL ERUPTS … || 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…

HEALTH INSURANCE PROVIDER’S FIGHT WITH HOSPITAL ERUPTS …

|| 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.

***

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77 comments

Crony #1 vs. Crony #2 February 20, 2015 at 10:19 am

Two scorpions in a bottle- let’s hope they both kill each other.

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mjskdkkfk@aol.com February 20, 2015 at 10:23 am

Happening all over the country.Kasich is a good man however expanding the Medicaid in Ohio was a huge mistake.

Over 200,000 have been dropped from the program as they failed to provide financial information (they had FREE insurance for almost a year before being terminated) and those enrolled are finding it almost impossible to find a doctor that will take Medicaid and the insurers they are using.

Just a debacle and wait until the ‘bill’ is due.

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The Colonel February 20, 2015 at 10:28 am

…Over 200,000 have been dropped from the program as they failed to provide financial information…

Sounds like 200,000 folks probably weren’t really eligible…

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just a mess February 20, 2015 at 10:33 am

That would make sense. About the only option for the NEW folks on Medicaid are walking into these new ‘minute clinics’ in pharmacies and seeing a nurse.

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grandtangosuglydog February 20, 2015 at 10:49 am

What are some of the saddest words in the English language?..”i have an AOL account” !!

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You've Got Mail! February 20, 2015 at 11:21 am

Remember those AOL frisbees they used to make? The ones that said FREE TRIAL on them?

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Correct February 20, 2015 at 10:52 am

This is LMC’s fault. They overcharge everyone to death. I stopped in to get blood work and a consultation, they billed me 4500 dollars for no insurance. I wish I had help from our president then, but alas shitty Bush was still in office. They offered to reduce my bill 33% if I paid with cash in full. I told them I would make payment arrangements gladly, but they said it would be the full 4500 if I did. So I let them take my tax return for the last six years and its still not fully paid. I hope the insurance company puts its foot down and refuses, and LMC along with all of its employees are shut down.Then there will be some change.

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Doh February 20, 2015 at 10:59 am

Too bad none of this will help cash-paying customers…

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Point of Order February 20, 2015 at 11:01 am

Exactly!

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Point of Order February 20, 2015 at 11:00 am

“I hope the insurance company puts its foot down and refuses, and LMC along with all of its employees are shut down.”

The problem is they’ve been fucking people without insurance for years, so even if they buckle to BCBS’s demands, it isn’t going to help the people that don’t have insurance as they have no hammer to swing.

In fact, our glorious SC gov’t colludes/props up the overcharging to those who can least afford it by seizing tax refunds.(why do you think LMC buys people like Nikki Haley?)

The whole thing is a corrupt mess, LMC, the SCDOI(which BCBS essentially runs), etc.

Toss is Obamacare mandates and it’s going to get even worse, if you can imagine that.

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george February 20, 2015 at 10:36 pm

Does anybody know how many millions of dollars of uncompensated care LMC provides to undocumented aliens?

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jimlewisowb February 20, 2015 at 10:53 am

Memory is a little faded but I recall Time Warner Cable and several media outlets taking their “failure to communicate” public a few months back to generate leverage

Both LMC and BCBS should have their POSASS kicked for raising the blood pressure of thousands of senior citizens

These two entities cannibalize each other 24/7 and neither is going to risk next weeks lunch over pocket change for their executives

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GrandTango February 20, 2015 at 11:48 am

Obama F*#ks it up…and abject Dumb@$$#$ like you attack the poor slobs who have to deal w/ it…
You F*#king IDIOT…You’re so F*#king Stupid you don’t deserve to vote…

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jimlewisowb February 20, 2015 at 12:21 pm

I don’t, reckon that will blow your piss the other wat

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snickering February 20, 2015 at 12:57 pm

Jimlewisowb, you are my favorite!

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Voting is a joke February 20, 2015 at 1:40 pm Reply
Rocky February 20, 2015 at 2:05 pm

Well that was packed with facts and emperical evidence to support your view. #)$(*%#!!!!

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nitrat February 20, 2015 at 11:10 am

Well…LMC is having to pay for that unneeded heart center and they’re upping their fees everywhere else in their system to do so.
THIS is a fantastic example of why Certificate of Need programs exist – to prevent hospitals/clinics from going insane chasing profits and causing healthcare costs for ALL to be

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say what? February 20, 2015 at 11:40 am

Consumers enrolled in Obamacare will see an increase in their insurance premium rates next year that will “easily” outpace inflation, with every insurer in at least one state opting for rate increases, The Wall Street Journal reported.

According to official filings by insurance companies in Virginia for 2015, average rate increases range from 3.3 percent to as high as 16.6 percent for those enrolled in the online exchange, depending on the type of plan a consumer holds.

The rate increases are directly related to the new costs insurers face under the Affordable Care Act due to the higher expense of insuring less healthy, previously uninsured enrollees, and also because of the new fees insurers are facing under the new healthcare law, one company, Anthem HealthKeepers Inc., told the Journal.

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guest February 20, 2015 at 11:56 am

I wish I had only an increase of 3.3 percent. Individual grandfathered plans with BCBS were once again socked with a 9.5% increase. That’s been the trend for over a decade. So everyone complaining about losing their old plans back, might want to rethink that grousing.

Different story for the ACA plans. The maximum change for BCBS plans was .86%, with the average being a decrease of around 2%. Check out the figures from the SC DOI of website. No one from BCBS or the SC DOI can give me a rational explanation as to why my grandfathered premium increase is more since I have less benefits and protections than the ACA plans.

http://www.doi.sc.gov/DocumentCenter/View/7835

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dem lies! February 20, 2015 at 12:16 pm

In 2017 when the insurance company’s kick backs from the federal government are over. Then we will start to see the true cost of the ACA. After 2016 elections.

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guest February 20, 2015 at 2:20 pm

And what was the true cost before ACA? What I’m paying now, over $9,000 a year? People act like insurance was cheap before the ACA and that there were no deductibles – It was a wonderland. Hogwash. If SC wanted to do something, they could start by cleaning house at the SC Doi who rubberstamp whatever increases the insurance companies request.

Good post! February 20, 2015 at 4:43 pm

The interesting thing about the SCDOI, aside from its corruption/cronyism, is that they are all dancing around the ACA and trying to keep the margin for their crony insurance friends.

It’s one gov’t regulator being regulated by another, larger regulator.

If there had been no SCDOI to start, S. Carolinians would have had more choices and better value for what they could afford.Now that Obamacare is here, it’s mitigating some areas of SC cronyism but creating a whole new series of problems with its own incompetency/malfeasance.

It’s basically trading one dictator for another.

Rocky February 20, 2015 at 11:57 am

Yet my ACA-compliant coverage through my employer went down like $17 a month this year. And let’s see, in the past before ACA you’de average 20% increases a year, and get fewer and fewer benefits. So I guess I’m not seeing your point.

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cuba February 20, 2015 at 12:07 pm

Ohio’s labor force shrank last year while Gov. John Kasich’s Obamacare expansion put nearly half a million Ohioans on Medicaid.

From December 2013 through December 2014, Ohio’s labor force declined by 20,506, based on U.S. Department of Labor data. Enrollment in Kasich’s Obamacare expansion, which took effect in January 2014, had rocketed to 485,462 by December.

Kasich, a Republican, unilaterally expanded Medicaid after critics expressed concern about federal spending, future state costs, access to care and the workforce impact of putting able-bodied, working-age adults on Ohio’s largest welfare program.

Ohio’s labor force declined by 71,498 during Kasich’s first term, narrowly increasing in 2013 after dropping in 2011 and 2012. Kasich boasts of reducing unemployment, although lower unemployment rates have resulted partly from the state’s shrinking workforce.

Two-thirds of Obamacare sign-ups in Ohio are on the FREE Medicaid.

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real America February 20, 2015 at 12:23 pm

People will wait until that skin has burned ,peeled and rotted before they pay that deductable.Too many people are living paycheck to paycheck and dont have the luxury of throwing money at a deductable until it becomes necessary.Which means they will wait until the pain becomes unbearable.

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helpless February 20, 2015 at 2:47 pm

ok, what do you want to do to help those people? they were not getting help before either

nitrat February 20, 2015 at 12:15 pm

Certificate of Need???

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can you read,son? February 20, 2015 at 12:17 pm

You brought up ‘inflation’ dumbass!

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LynnTTTT February 20, 2015 at 5:46 pm

Health care costs have not been rising with inflation for 15 years. The costs have been way above inflation. Costs have been increasing at lower rates than before Obamacare.

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george February 20, 2015 at 10:34 pm

I’m curious if the rise of college tuition has outpaced the rise of medical costs…over the past ten years…I would be curious to know how many tens of billions of dollars are spent by hospitals to provide free care for illegal aliens…

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GrandTango February 20, 2015 at 11:45 am

SQUEAL PIG SQUEAL!!!!…LMAO….
You’re not THAT stupid are you???…Hahahaha

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nitrat February 20, 2015 at 12:14 pm

Certificate of Need??

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ward of the state February 20, 2015 at 2:45 pm

he has a certificate of need for the state to send someone to his house to make sure he isn’t smearing the walls with poop

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Saluda Rapids February 20, 2015 at 4:54 pm

Ha!

say what? February 20, 2015 at 11:45 am

“Thus, even if Obama’s claim of continuing year-after-year declines in heath care inflation were correct, that track record will likely end this year — because of the Affordable Care Act.”

Washington Post

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nitrat February 20, 2015 at 12:14 pm

Certificate of Need?

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ELCID February 20, 2015 at 2:06 pm

When we tried to stop LEX. Hospital rip offs in the early days thru the 3 Rivers Central Planning Commission for Hospitals, they called in the Lobbyist to get the businessmen off the Commission. They didn’t want any people on the Commission who knew where to look to find the kick back schemes they were running at that hospital.

They even fired a major whistle blower last year that tried to warn about the crooked accounting at the Hospital. The FBI needs to look at these crooks top to bottom. SLED can’t be trusted to do a proper investigation with Haley looking over their shoulders.

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Alice Burdge February 20, 2015 at 3:12 pm

Too bad the “whistle blower” is going to find out it was a mistake to lie to the FEDS!

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ELCID February 20, 2015 at 3:27 pm

Whistle Blower didn’t lie to the FEDS.

The truth is something that is kept hidden away at Lex. Hospital’s operations.
The only group that should be concerned about a FED investigation are the ones at Lex. Hospital hiding these truths. Maybe like yourself.

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Lexdem February 20, 2015 at 5:29 pm

Obviously, you know very little.

ELCID February 20, 2015 at 5:43 pm

I know a lot more than you think.
That’s for sure, and that’s all I’m going to say about it.
Time will tell, and eventually the truth’s will come out.

Lexdem February 20, 2015 at 6:12 pm

No…you are out-of-date and flawed, at best. You know NOTHING.

ELCID February 23, 2015 at 10:42 am

LemDem Stop schelling for LEX. Hospital.
You are disgusting.

A hospital without a proper Trauma Center is not a hospital at all. Lex. is just an outpatient money machine for the various groups using it. All paid for by the taxpayers of Lexington County.

We didn’t need a Heart Hospital. What we needed was a Trauma Center, and still do. There’s only one in the entire middle of South Carolina: Richland Memorial. And that’s just dangerous.

Lexdem February 26, 2015 at 7:02 am

Too bad, so sad…everything worked out! Just like it did for the heart surgery and LMC continues to kick-ass in the MIdlands of SC!!! You pathetic losers(Kevin Hall, James Smith, etc) can continue to throw obstacles in their way but market-share is GOING to LMC! Get used to it!!! Oh, and your Dr Whistleblower will turn out to be the drunken slob that we all know he is!

ELCID February 26, 2015 at 10:22 am

It’s you Kool Aid drinkers that just accept every thing the Haley Lex crooks feed you that keep killing our taxpayers and citizens.

Wake the Heck up!!

Just look at the Blue Cross Blue Shield deal this week. They refused to pay for the outrageous charges Lex. Hospital was sticking the Lex Citizens with for just regular services. They caught Lex. Hospital RED HANDED, passing on excessive Heart Hospital costs to other areas of the hospital in order to hide the subsidies. And, they refused to pay for them. Lex. Hospital had to make a special deal with Blue Cross to reduce those charges to their customers, or Big Blue was going to drop them permanently. And, Lex. agreed.

All they are doing now is upping the charges to other insurance companies and poor people without insurance.

By the way Lex. Hospital Heart Hospital performs so few operations and has a such a short history that they are not recommended by any oversight group in the country as a safe place to get heart work done.

I won’t trust my family to a Rookie Heart Hospital, when there are already 2 pros in town.

Lexdem February 26, 2015 at 4:30 pm

BLA…BLAA…BLAAA. LMC did 300 heart surgeries THEIR FIRST YEAR!!! That’s hardly “so few”. It’s morons, like you, that think you can just make up shit and spew it. BTW, Nikki hates LMC and vice versa, just so you know. In case you’ve been in a coma, there is bad blood between her and the hospital. AND, you are way off base on what happened between BCBS and LMC. What a friggin’ dumbass you are!!!!

ELCID February 26, 2015 at 5:04 pm

From your use of the English language and your complete lack of common sense, the actual moron in this blog is obviously you.

End of discussion: you are too ignorant to even have a logical interaction. Exactly the person Haley needs to stay in office.

Lexdem February 26, 2015 at 6:23 pm

touche` douche-bag

snickering February 21, 2015 at 2:12 pm

He actually knows nothing. Patients prefer Palmetto Richland Hospital. One woman was sitting in Lexington Hospital Waiting Room having a Heart Attack. Luckily her Son was with her and had her transported to Palmetto Richland Hospital. I myself had 3 brothers die at Lexington Hospital and a Doctor wouldn’t even talk to me. Lexington Hospital can Rot In Hell.

What?!?! February 20, 2015 at 4:48 pm

“THIS is a fantastic example of why Certificate of Need programs exist in
various states – to prevent hospitals/clinics from going insane chasing
profits, building centers for this and that which are NOT needed and
causing healthcare costs for ALL to be inflated to obscene levels.”

This is an incredibly ridiculous statement.

#1 Hospitals of this nature are operating with the aid of taxpayer money. Nobody knows what the actual “need” is because government itself doesn’t know.

#2 Basic supply and demand means that when you have “overcapacity” or excess supply(in this case heart surgery centers; your example) in a market with any sense of free exchange(and granted, that’s a dubious claim in this example, but probably somewhat relevant none the less) the price falls…IT DOESN’T GO UP.

That is all.

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nitrat February 22, 2015 at 10:47 am

To think of any facet of the medical business – hospitals, MDs, other providers – as being a real free market and acting like one, you must have not considered your own or your family’s experiences with it. And, certainly have never read anything about how it operates.

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Jackie Chiles February 23, 2015 at 10:05 am

By and large, the hospitals are not free market enterprises specifically because of regulations like needing “certificates of need” to open additional facilities.

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GrandTango February 20, 2015 at 11:46 am

If you voted for Obama YOU Deserve this…I don’t….

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Rocky February 20, 2015 at 11:58 am

Deserve what? I don’t use LMC anyway – so I really don’t give a Flip, or a pork chop!!!

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GrandTango February 20, 2015 at 12:08 pm

This is just the beginning…you cannot FORCE hundreds of thousands more of Free-Care patients in SC, and not expect US – who actually pay – to have to foot the bill…

IOW: Obama LIED….Healthcare DIED…

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after the election February 20, 2015 at 12:13 pm

In 2017 when the insurance company’s kick backs from the federal government are over. Then we will start to see the true cost of the ACA.

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GrandTango February 20, 2015 at 12:23 pm

Like ALL coward Democrats…they were FOR IT…until it comes out of their pocket….LMAO…Then they’ll be against it…
Liberalism is like Communism. You can force it on people…but it will ALWAYS collapse on itself…

Try To Keep Up February 20, 2015 at 2:18 pm

For once, an astute observation. A truism indeed.
Now, if we can just cut out your hypocrisy, circumvention, and liberal bully tactics that you so decry.

Medicaid February 20, 2015 at 6:37 pm

????Don’t you forget about me…????

vicupstate February 20, 2015 at 12:46 pm

you and WE were already paying for those that weren’t, through higher charges and premiums on those that were paying.

You are just to close minded and stupid to understand.

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GrandTango February 20, 2015 at 1:03 pm

I knew that. I told your Dumb-@$$…Obama is just adding millions and millions more…Idiot…

RogueElephant February 20, 2015 at 12:58 pm

The couple of times I have been to LMC I was satisfied completely with the hosp. the staff and everything except the administration. LMC could be a great medical facility with a through cleaning out in admin. It is sad that an otherwise outstanding org. has to put up with that.

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UsOldFolks February 20, 2015 at 1:00 pm

While my preference of all the Columbia hospitals is LMC (cleanliness, friendly staff for the most part, availability, and closeness) (I live in West Columbia), I will have to admit that they seem to be money-grubbers. Apparently a dispute in fees charged for emergency room attendance on weekends was the reason that “my” orthopedic group no longer uses LMC (nor, apparently, does the other large orthopedic group in town), and generally I have to go to Palmetto Baptist or the “new” Providence Orthopedic hospital for most of my procedures – emergency or otherwise (I have some cardiac risk). I am also very aware of the “prima donna” problem that affects all three of their houses.

I am also no great fan of BC/BS, and I concur with the comment below/above about two scorpions in a bottle.

Relative to the “Certificate of Need” – Does anyone in their right mind think that eventually DHEC will deny a CON to LMC??? There may be a new commissioner on the way (Kitzman or otherwise), but current politics will guarantee a CON to LMC in the long run.

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Nikki Haley YOUR Governor February 20, 2015 at 1:07 pm

Thanks for all your support!

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not my gov February 20, 2015 at 2:48 pm

nikki sucks

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jimlewisowb February 21, 2015 at 11:43 am

what?

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ELCID February 20, 2015 at 2:01 pm

Lexington has always been too high. It’s probably correct for Blue Cross to stop supporting this rip off. I guess when they bought Gov. Haley, Lex. Hospital figured they could just charge anything they wanted too. WRONG!

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Rocky February 20, 2015 at 2:14 pm

Given that BCBS has a huge chunk of the SC market – I’m guessin LMC will cave in and lower their costs. Hey, wasn’t that NOT supposed to happen under Obamacare? I’m confused again. Maybe Grand Pok Chop can enlighten me? #@$%#!!!

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george February 20, 2015 at 10:39 pm

Does anyone know the relative salaries of the CEO’ s of Blue Cross vs LMC?

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edr February 20, 2015 at 8:11 pm

Blue Cross/ Blue Shield offered Medigap policy holders a 20% discount
on premiums if they would opt out of using Lexington Medical Center
Hospital last year. I took them up on their offer.

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Quinn February 20, 2015 at 8:42 pm

LMC is out of control on spending. They spend massive amounts on expensive media buys, the sports event and LMC ticket sponsorships are unnecessary and they sponsor every chamber and festival in town. No wonder Blue Cross says it is not going to continue to pay for this nonsense. What LMC isn’t saying is that it spent a fortune on its medical records migration and wants to build ANOTHER tower with several hundred rooms. And, what about that 10 million in “free money” it got last year from investment proceeds? They slid that in through their foundation back door. They still haven’t come clean on the settlement with Haley. Good for insurance companies standing up to these spendthrifts and making them be accountable for the loads of cash they waste.

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Robert February 21, 2015 at 3:31 pm

Easy people. This is all bullshit just like when the cable or satellite providers fight about programming. This type thing was going on before Obamacare. LMC nor BCBS are not stupide enough to let this end in divorce.

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edr February 22, 2015 at 10:37 am

How much did the ad in the Sunday state newspaper cost lmc,about 10 page spread??

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edr February 22, 2015 at 10:39 am

I heard the president is retiring just before medicare fraud report is to be issued.

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ghost of Al Goldstein February 23, 2015 at 12:27 pm

Obamacare death panel P*n’s BC/BS and has decided what is reasonable for evil doctors to earn, as opposed to injury lawyers and litigators that will feed off of the earnings as cases are filed against both. Let’s go back to the 60s-70s when the cancer that is healthcare entitlement was a wee bitty tumor and docs wrote so much off pro bono.
Granted it sends many overpaid HHS nabobs out to find free wifi to watch pron on instead of broadband that comes out of my pocket

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SCSoonerfan February 23, 2015 at 5:35 pm

Lets see 90 million profit+poor quality scores=overcharging for services. But lets be realistic. There will be posturing, bitching and moaning but by May Lexington will cave. They cannot survive without BCBS money.

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