It is not just the physicians at Medical College of Georgia Hospital and Clinics who are having a hard time with a Blue Cross Blue Shield insurance company.
A national survey of hospital leaders found the parent company of many Blue Cross branches, Anthem/WellPoint, to be the worst to deal with in term of contracts, rates and overall.
The survey, however, was put together this month by ReviveHealth, which was hired by MCG health system to help it with public relations during its public spat with Blue Cross Blue Shield of Georgia. The health system is threatening to terminate its contract with Blue Cross on Aug. 15 because monthslong negotiations on new rates are seemingly going nowhere.
The two sides cannot even agree on how much of an increase the MCG practice plan is asking for. The plan says it is asking for an average of 13 percent; Blue Cross says it is nearly three times that amount.
“(That) demand is extraordinary and simply not sustainable,” Blue Cross said in a statement. “As the majority of our business is self-insured, any substantial increase will directly affect the overall cost of care in the Augusta community. Just one of our large customers in Augusta would be impacted by more than $1 million annually.”
Nonsense, said Frank Smith, the chief operating officer for the practice plan. The two sides had been in agreement on the numbers until lately, when Blue Cross came back and said MCG was asking for a 35 percent increase, he said.
“Their calculations are wrong,” Smith said.
It is just the latest protracted contract dispute with Georgia’s Blue Cross, and it seems to be part of a pattern played out nationwide with other branches, said Brandon Edwards, the president of ReviveHealth, who has helped hospitals in similar negotiations.
“There is a playbook (they follow), he said. “They may not want to call it that or acknowledge it.”
Events, and even certain statements, seem to follow the same timeline, he said. It seems to have worsened in the past year, Edwards said.
For the first time in the six years that ReviveHealth has done the hospital survey on insurers, Anthem/WellPoint is at the bottom of the favorability list and ranked worst for contract negotiations.
Edwards said it was “just a remarkable change” from previous years.
Blue Cross responded that “the sample size is relatively small” for the ReviveHealth survey and that its own provider feedback survey from customer service found 90 percent were satisfied with the resolution of the problem.
MCG Hospital, which is in separate negotiations from its physicians, has been working on a new contract with Blue Cross for more than two years, said Greg Damron, its interim chief financial officer. Though the two sides are fairly close on the financial details and agreed on many items in May, the hospital is siding with the physicians and terminating the contract Aug. 15 because it would set up a nightmare for patients if one were in network but the other weren’t, he said.
It’s confusing to patients, Damron said. Those patients include Georgia Health Sciences University employees because Blue Cross administers the plan for the University System of Georgia, he said. If the relationship is severed, some could continue to use MCG facilities and physicians and pay more, but others would not receive any coverage, Damron said.
“It really is a mess for patients to deal with,” he said, if it comes to that. And it would affect not only the Georgia Blue Cross plan but also every other one, he said.
“It would cover every Blue Cross Blue Shield plan in the country,” Damron said.
For its part, Blue Cross said it is committed to reaching an agreement with MCG physicians and the health system. The insurance giant, which is the largest commercial payor for MCG health system, said it has “proposed rates of increase over multiple years ... that have moved the parties closer together and that exceed the Consumer Price Index.”
The sides will continue to talk, but Smith said he has seen no progress yet.
“I am neither optimistic nor pessimistic,” he said. “We have some time to work it out. Their history suggests that things do get worked out after notices have gone to patients. I think there is a possibility, but I have no reason to be optimistic because we haven’t made any progress.”