Blue Cross Coverage Continues at Los Angeles County Hospitals
The Department of Managed Health Care on Friday ordered WellPoint to extend coverage under its Blue Cross of California subsidiary for health plan members at three hospitals in Los Angeles County, the Los Angeles Times. The order requires the insurer to cover services at Centinela Freeman HealthSystem hospitals as in-network facilities through March 15, despite the expiration of the contract between the hospital system and Blue Cross on Wednesday.
Centinela Freeman HealthSystem administrators say that Blue Cross's reimbursement rates are inadequate and that the hospital system's financial losses would increase under the insurer's proposed reimbursement plan.
Blue Cross officials say the hospitals are reimbursed at higher rates than other hospitals, in part because Tenet Healthcare, the hospitals' former owner, used its size to negotiate more favorable reimbursement rates.
Blue Cross has asked DMHC for permission to send its members to other local hospitals if it does not reach an agreement with Centinela Freeman. Under the proposal, services would be reimbursed at lower, out-of-network rates at the facilities.
DMHC spokesperson Lynne Randolph said the agency ordered the two-week extension to review Blue Cross' proposal.
Centinela Freeman HealthSystem operates Centinela Hospital in Inglewood, a nearby Memorial campus and a campus in Marina del Rey. The facilities operate about 800 hospital beds in Los Angeles County (Girion, Los Angeles Times, 2/25).
DMHC's order is available online. Note: You must have Adobe Acrobat Reader to access the document.