Blue Cross of California Ends Contract with HCA Healthcare

Blue Cross of California on Oct. 1 terminated its contract with HCA Healthcare after the two sides were unable to reach an agreement on reimbursement rates, the San Jose Mercury News reports. As a result, Blue Cross members in the Bay Area will no longer have access to most elective procedures at Good Samaritan Hospital, San Jose Medical Center or the Regional Medical Center of San Jose. For their part, HCA officials said the rates Blue Cross offered during negotiations were "extremely low." HCA spokesperson Leslie Kelsay said the offered rates were lower than current Medicare reimbursement levels (Sevrens Lyons, San Jose Mercury News, 10/6). However, in a statement on its Web site, Blue Cross said it was unable to "achieve a fair and reasonable price for quality health care services." The contract termination impacts Blue Cross' preferred provider organization, HMO and point of service members. Blue Cross will continue to cover emergency care at the facilities, and pregnant women with expected due dates on or before April 15, 2003, still can access HCA facilities. Blue Cross will no longer authorize or approve scheduled or elective procedures at the HCA facilities, but care authorized before Oct. 1 and provided through Oct. 31 will be covered (Blue Cross release, 10/1). HCA officials said the contract termination is evidence that Blue Cross is making treatment decisions, adding that the insurer would be responsible for any "disruption[s]" in care that patients experience, the Mercury News reports. Blue Cross spokesperson Michael Chee said, "HCA hospitals are not the center of the universe here. There are plenty of alternatives." Joanne Spetz, a health policy expert at the University of California-San Francisco, said, "Negotiations come to this brinkmanship almost all the time. ... The fact that it actually came to a dropping of those hospitals is pretty significant" (San Jose Mercury News, 10/6).