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::Blue Cross Patients Out Of Luck In Triad

By Richard Saunders, The Raleigh Chronicle
Friday, August 24, 2007

GREENSBORO - Patients with the state's largest health insurer will face big problems this fall, due to Blue Cross and Blue Shield's big battle with Moses Cone Hospital in Greensboro over reimbursement costs. 

Most recently, they've taken their battle to Greensboro newspapers with both sides trying to bash each other in print and even taking out full-page advertisements to sway the public.

Healthcare Battle Starts

The battle started earlier this year when the two sides tried to negotiate prices for certain procedures that are covered under health insurance.  Traditionally, hospitals have stated that they have one price for all procedures, but give health insurers, HMO's and other group plans discounts that charge much less than the "retail" price.

When the negotiations broke down and both sides reached a stalemate, Moses Cone Hospitals announced that on November 1st, they would no longer accept Blue Cross and Blue Shield patients under the health plan.  The patients could still receive services at the hospital, but would not be reimbursed by Blue Cross, which is headquartered in Chapel Hill.

"Over the last few weeks it has become apparent that Blue Cross is not interested in a new contract that compensates us fairly for the care we provide to its members," said Moses Cone Health System CEO Tim Rice in a press release.

Blue Cross and Blue Shield fired back, saying that Moses Cone was out of line.

"We are committed to good working relationships with the doctors and hospitals treating BCBSNC members in all 100 North Carolina counties," said a BCBS press release.  "But some demands are just not reasonable...that's the case with the demand by Moses Cone Health System."

Elimination Of Competition

In an area where there are competing health systems, this type of issue might not be a large problem.  For example, in the Triangle area of North Carolina, patients can choose from competing health care providers such as WakeMed, Rex Hospitals, Duke Hospitals, UNC Healthcare, and others.

However, in Greensboro, there is only one major hospital system -- Moses Cone.  The hospital group used to have competition in the form of Wesley Long Hospital and the Humana Hospital, but those two hospital groups as well as other hospitals like Annie Penn Hospital in Rockingham County were acquired by Moses Cone in the 1990's.

Moses Cone now runs every single hospital complex in the city of Greensboro.

Some in the Greensboro health community opposed the mergers since they said it would effectively eliminate competition, but Moses Cone officials said it was done to "improve efficiency."

Blue Cross Criticism

Blue Cross has not escaped criticism either in recent years.  In 2002, under the current leadership, the firm had proposed changing its status from a "non-profit" to a "for-profit" company, allowing the company to divvy up a large cash reserve, potentially among its executives.

When patient and legislative criticism derailed that plan, the company decided not to proceed with the plan.

In recent years, despite health cost increases, Blue Cross has enjoyed a healthy bottom line -- and has shared that with its executives.

In 2006, the company posted a record profit of $190 million and paid CEO Bob Greczyn a whopping $3.1 million in compensation.

Both sides fault each other for spiraling health care costs that cost the consumer more money each year.

Either way, although patients are covered in the case of an emergency, the end result is that 120,000 BCBS insured patients in Guilford County may not have any choice but to go to hospitals in other counties in order to get basic care and routine procedures.

Battle In Print

Both CEO's of Blue Cross and Moses Cone wrote letters to the editor that were printed in the August 9th edition of the Greensboro News & Record newspaper to make their points to the public.

CEO Bob Greczyn of Blue Cross said that Moses Cone was being unreasonable in their rate requests, asking why an x-ray at Moses Cone costs six times as much at comparable hospitals.

CEO Tim Rice of Moses Cone hospitals said that they have billed less to BCBS than to other insurance companies for years and that Blue Cross was more interested in "protecting its profits instead of devoting your premium dollars to quality care."

Later on Thursday August 16th, Moses Cone Health Care took out a full page advertisement on page 2 of a free weekly Greensboro newspaper called The Rhinoceros Times.  The advertisement provided the phone number and e-mail of Blue Cross CEO Bob Grecyn and asked patients to tell him that "we don't think it's fair that the rest of our community should subsidize Blue Cross profits."

Someone Is Lying

The two sides seem to be at an impasse and can't even agree on negotiation details.  Both sides seem to be making claims, that if true, means at least one side is lying.

For example, each company claims that the other side was the one to leave the negotiating table.

"Although we repeatedly requested to continue negotiations, Blue Cross refuses to do so," says the advertisement in the Greensboro newspaper placed by Moses Cone Health Care.

Blue Cross contends the exact opposite -- that it was Moses Cone that refused to continue to negotiate.

"With BCBSNC standing firm against the large fee increase demand, Moses Cone has walked away from discussions, canceling its contracts," said Blue Cross in a press release.

Other major disparities exist in how each side presents its case.

Moses Cone says that they are a relative bargain compared to other hospitals in what they charge Blue Cross.

"Blue Cross is well aware that Moses Cone Health System charges an average of 45 - 50 percent less than other hospitals in North Carolina," claims the Moses Cone Health System advertisement.

Blue Cross would have you believe the opposite according to their statements.

"For some common scans and diagnostic procedures, Moses Cone is demanding two to six times as much as the best rates BCBSNC members can get at other facilities in the community," claims Blue Cross.

These two statements are hard to reconcile, given they are so far apart.

Patients Worried About Deadline

Either way, Blue Cross Blue Shield patients in Greensboro are growing increasingly worried that on November 1st, the problem will not be resolved.  Some may switch insurance plans, but for those who have pre-existing conditions that would not be covered by a new insurer, that is clearly not an option.

As a result, some have called for state regulators or legislators to step in to force a compromise between Moses Cone and Blue Cross and Blue Shield.

Despite this state's growing reputation as a bastion of up and coming hospitals and innovative health technologies, patients in Greensboro may have to drive 30 miles or more to Winston-Salem, Durham, or Raleigh to go to the hospital. ::

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::Blue Cross Patients Out Of Luck In Triad

By Richard Saunders, The Raleigh Chronicle
Friday, August 24, 2007

GREENSBORO - Patients with the state's largest health insurer will face big problems this fall, due to Blue Cross and Blue Shield's big battle with Moses Cone Hospital in Greensboro over reimbursement costs. 

Most recently, they've taken their battle to Greensboro newspapers with both sides trying to bash each other in print and even taking out full-page advertisements to sway the public.

Healthcare Battle Starts

The battle started earlier this year when the two sides tried to negotiate prices for certain procedures that are covered under health insurance.  Traditionally, hospitals have stated that they have one price for all procedures, but give health insurers, HMO's and other group plans discounts that charge much less than the "retail" price.

When the negotiations broke down and both sides reached a stalemate, Moses Cone Hospitals announced that on November 1st, they would no longer accept Blue Cross and Blue Shield patients under the health plan.  The patients could still receive services at the hospital, but would not be reimbursed by Blue Cross, which is headquartered in Chapel Hill.

"Over the last few weeks it has become apparent that Blue Cross is not interested in a new contract that compensates us fairly for the care we provide to its members," said Moses Cone Health System CEO Tim Rice in a press release.

Blue Cross and Blue Shield fired back, saying that Moses Cone was out of line.

"We are committed to good working relationships with the doctors and hospitals treating BCBSNC members in all 100 North Carolina counties," said a BCBS press release.  "But some demands are just not reasonable...that's the case with the demand by Moses Cone Health System."

Elimination Of Competition

In an area where there are competing health systems, this type of issue might not be a large problem.  For example, in the Triangle area of North Carolina, patients can choose from competing health care providers such as WakeMed, Rex Hospitals, Duke Hospitals, UNC Healthcare, and others.

However, in Greensboro, there is only one major hospital system -- Moses Cone.  The hospital group used to have competition in the form of Wesley Long Hospital and the Humana Hospital, but those two hospital groups as well as other hospitals like Annie Penn Hospital in Rockingham County were acquired by Moses Cone in the 1990's.

Moses Cone now runs every single hospital complex in the city of Greensboro.

Some in the Greensboro health community opposed the mergers since they said it would effectively eliminate competition, but Moses Cone officials said it was done to "improve efficiency."

Blue Cross Criticism

Blue Cross has not escaped criticism either in recent years.  In 2002, under the current leadership, the firm had proposed changing its status from a "non-profit" to a "for-profit" company, allowing the company to divvy up a large cash reserve, potentially among its executives.

When patient and legislative criticism derailed that plan, the company decided not to proceed with the plan.

In recent years, despite health cost increases, Blue Cross has enjoyed a healthy bottom line -- and has shared that with its executives.

In 2006, the company posted a record profit of $190 million and paid CEO Bob Greczyn a whopping $3.1 million in compensation.

Both sides fault each other for spiraling health care costs that cost the consumer more money each year.

Either way, although patients are covered in the case of an emergency, the end result is that 120,000 BCBS insured patients in Guilford County may not have any choice but to go to hospitals in other counties in order to get basic care and routine procedures.

Battle In Print

Both CEO's of Blue Cross and Moses Cone wrote letters to the editor that were printed in the August 9th edition of the Greensboro News & Record newspaper to make their points to the public.

CEO Bob Greczyn of Blue Cross said that Moses Cone was being unreasonable in their rate requests, asking why an x-ray at Moses Cone costs six times as much at comparable hospitals.

CEO Tim Rice of Moses Cone hospitals said that they have billed less to BCBS than to other insurance companies for years and that Blue Cross was more interested in "protecting its profits instead of devoting your premium dollars to quality care."

Later on Thursday August 16th, Moses Cone Health Care took out a full page advertisement on page 2 of a free weekly Greensboro newspaper called The Rhinoceros Times.  The advertisement provided the phone number and e-mail of Blue Cross CEO Bob Grecyn and asked patients to tell him that "we don't think it's fair that the rest of our community should subsidize Blue Cross profits."

Someone Is Lying

The two sides seem to be at an impasse and can't even agree on negotiation details.  Both sides seem to be making claims, that if true, means at least one side is lying.

For example, each company claims that the other side was the one to leave the negotiating table.

"Although we repeatedly requested to continue negotiations, Blue Cross refuses to do so," says the advertisement in the Greensboro newspaper placed by Moses Cone Health Care.

Blue Cross contends the exact opposite -- that it was Moses Cone that refused to continue to negotiate.

"With BCBSNC standing firm against the large fee increase demand, Moses Cone has walked away from discussions, canceling its contracts," said Blue Cross in a press release.

Other major disparities exist in how each side presents its case.

Moses Cone says that they are a relative bargain compared to other hospitals in what they charge Blue Cross.

"Blue Cross is well aware that Moses Cone Health System charges an average of 45 - 50 percent less than other hospitals in North Carolina," claims the Moses Cone Health System advertisement.

Blue Cross would have you believe the opposite according to their statements.

"For some common scans and diagnostic procedures, Moses Cone is demanding two to six times as much as the best rates BCBSNC members can get at other facilities in the community," claims Blue Cross.

These two statements are hard to reconcile, given they are so far apart.

Patients Worried About Deadline

Either way, Blue Cross Blue Shield patients in Greensboro are growing increasingly worried that on November 1st, the problem will not be resolved.  Some may switch insurance plans, but for those who have pre-existing conditions that would not be covered by a new insurer, that is clearly not an option.

As a result, some have called for state regulators or legislators to step in to force a compromise between Moses Cone and Blue Cross and Blue Shield.

Despite this state's growing reputation as a bastion of up and coming hospitals and innovative health technologies, patients in Greensboro may have to drive 30 miles or more to Winston-Salem, Durham, or Raleigh to go to the hospital. ::

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::Blue Cross Patients Out Of Luck In Triad
 
Patients with the state's largest health insurer will face big problems this fall, due to Blue Cross and Blue Shield's big battle with Moses Cone Health System (above) in Greensboro over reimbursement costs.
 
Photo From Moses Cone Hospitals
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Statement From Moses Cone:  July 30, 2007

"Moses Cone Health System has been trying to renegotiate our contract with the state's biggest managed care company, Blue Cross Blue Shield of North Carolina. In fact, we have been working for several months on a new contract that includes competitive rates for the care we provide to everyone with a Blue Cross card.

"Over the last few weeks it has become apparent that Blue Cross is not interested in a new contract that compensates us fairly for the care we provide to its members. This is a critical issue for us because fair reimbursement ensures that we can provide quality care and retain the top quality nurses and staff that people expect at Moses Cone Health System. Since Blue Cross has been unwilling to compromise, we are left with no choice but to terminate our contract, effective Nov. 1.

"We have been very reluctant to take this step because we don't want to cause any anxiety for this community. Yet Blue Cross has left us with no other choice, and we hope that this step will show them how seriously we take this issue. Blue Cross reimbursement rates have fallen far behind other insurance companies, and we simply cannot continue to accept inadequate reimbursement from our largest private payor. We can't let anything put quality care and access at risk.

"We are continuing discussions with Blue Cross, but we are still far apart, and we will not continue as participating providers unless we agree on acceptable terms.

"We are working very hard to avoid such a situation. The last thing we want is a disruption in the care we provide to our patients. We hope Blue Cross will join us in doing everything they can to provide their members the care they need and deserve."
Statement From Blue Cross:  July 30, 2007

"We are committed to good working relationships with the doctors and hospitals treating BCBSNC members in all 100 North Carolina counties. But some demands are just not reasonable.

That's the case with the demand by Moses Cone Health System for an 18 percent hike in fees immediately, and 36 percent jump by July 2009. For example, Moses Cone wants to charge two to six times as much as other facilities in the community for services such as chest X-rays, MRIs and CT scans.

We know that our members are counting on us to hold the line on such outrageous pricing. Let's face it  when we pay more to hospitals, you pay more in health insurance premiums.

We increased the hospital system's fees just last year, including a double-digit percentage increase for inpatient care. A demand for tens of millions of dollars more is out of line. We estimate that Moses Cone's price hikes alone could drive up Triad member premiums by five percent.

Moses Cone cancelled its contracts effective November 1 without regard to how this affects you. We think it is wrong to use our members as bargaining chips in this way.

Fortunately, the BCBSNC network includes 11 other hospitals within about 35 miles of Moses Cone, so you have access to medical care. Remember that in an emergency, care is always covered at in-network levels. Members in an emergency are urged to go to the nearest hospital.

We are sorry that Moses Cone has tried to put our members in the middle of this financial dispute. We will work to transition members smoothly to other participating facilities. And we will continue to work to hold down hospital costs.

Thank you for your patience as we transition care arrangements to participating hospitals where your out-of-pocket costs can be minimized."