CATHOLIC HEALTHCARE WEST: Poised To Cut Off Blue Cross Patients
Catholic Healthcare West announced Friday it will suspend all contract negotiations with Blue Cross of California effective July 7, unless the managed care company agrees to provide what CHW considers "fair and accurate payment." CHW Senior Vice President J. Michael Gallagher said, "While we're hopeful that we can reach agreement, we felt it was incumbent to let our patients know that if we do not have a level of reimbursement that is required, then we will have to terminate the contract. Blue Cross has known this for months" (Warchol, Ventura County Star, 6/28). The San Mateo County Times reports that the hospital network will "begin notifying Blue Cross patients immediately that their coverage will be terminated" unless CHW's demands are met. About 30,000 patients will be forced to either find new insurance or a new hospital, or pay more for services at a CHW facility (Sussman, 6/27). Blue Cross and CHW are already working out a "transition arrangement so patients already approved for surgeries could still have them covered under their Blue Cross health plans." The Ventura County Star reports that 30 of CHW's 35 hospitals statewide contract with Blue Cross. The HMO represents about 4% of the hospital chain's business (6/28).
The Same Old Song
The San Mateo County Times reports that Blue Cross faced a similar situation with Sutter Health last month. "Weeks after Sutter began notifying Blue Cross patients their care would be terminated, Sutter reconsidered and renewed the contract," the San Mateo County Times reports. Bob Polzoni, CHW's regional director of corporate communications, said such a resolution is unlikely in this case. "We have no intention of going back to the table unless we move much closer together. We're far, far apart," he said (6/27). Dr. Kevin Fickenscher, chief medical officer of CHW, said, "The care we provide must be supported by fair and equitable reimbursement to cover the increasingly complex and intensive ways that health care services are delivered" (Hamm, Los Angeles Times, 6/28).
Blue Cross spokesperson Cynthia Coulter said CHW should be trying to negotiate individual contracts with each hospital, as opposed to one large contract for the health system. "They're still asking us for increases way above and beyond what we just settled for with other large hospital systems like Tenet, Sutter and Adventist," she said (Ventura County Star, 6/28). The San Mateo County Times reports that Blue Cross members "who have questions should call the Blue Cross service number printed on the back of their card, or call the CHW hotline at 1-888-249-0101" (6/27).