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Hospital, Blue Cross impasse reaches deadline

The contract termination leaves Blue Cross customers responsible for paying out-of-network costs at Wayne Memorial for non-emergency care. "In order to protect our patients' access to care at their local hospital, and to give employers time to look into other insurance options that include Wayne Memorial as in in-network hospital, our Board of Directors has...

By Rochelle Moore, The Wilson Daily Times, N.C.
McClatchy-Tribune Information Services

Dec. 05--Blue Cross Blue Shield of North Carolina and Wayne Memorial Hospital were unable to reach an agreement that stops the cancellation of the hospital's contract starting today.

Wayne Memorial Hospital has provided some concessions that will allow patients to continue receiving inpatient care at in-network costs through March 2014.

The contract termination leaves Blue Cross customers responsible for paying out-of-network costs at Wayne Memorial for non-emergency care. Emergency care will remain in-network and the changes will not affect Blue Medicare SM/Medicare Advantage plans. Physicians will not be affected by the change.

In an effort to help residents adjust to the change, Wayne Memorial Hospital's Board of Directors decided to treat affected patients as in-network for four months and will cover the additional cost of care.

"In order to protect our patients' access to care at their local hospital, and to give employers time to look into other insurance options that include Wayne Memorial as in in-network hospital, our Board of Directors has decided to work with Blue Cross customers' out-of-pocket costs at their current rate of coverage -- the same as if Blue Cross had kept the hospital in its network -- through March 31, 2014," said Rebecca Craig, vice president of finance at Wayne Memorial in Goldsboro.

"Additionally, we will extend in-network rates to Blue Cross members for obstetrics services through December 31, 2014. This means there will be no change in the amount most of our patients pay for care at Wayne Memorial Hospital if we are out-of-network versus being in-network.

"We do not want patients to delay care or travel out of town when quality care is available locally at Wayne Memorial Hospital with the physicians they know and trust."

Blue Cross officials issued a statement Tuesday saying that hospital leaders have rejected their final contract offer. Blue Cross is also moving forward and preparing for the hospital to be an out of network provider.

Hospital officials have said that Blue Cross' last offer would have led to a $9 million in revenue cuts during the next three years. BCBS officials deny the claim that Wayne Memorial is going to suffer financially from a new contract and that the losses are based on the hospital's "inflated rates."

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"We have been sensitive to Wayne Memorial's concerns about decreased revenue, offering reasonable reductions in outpatient costs combined with increases for inpatient services," said Lisa Cade, BCBS vice president of network management. "We also offered guaranteed increases for the next two years. However, Wayne Memorial continues to demand rates more than 70 percent higher than statewide average along with higher guaranteed future rate increases than any other hospital in the state."

Wayne Memorial's contract with Blue Cross has remained nearly the same since the 1990s, said Mark Werner, BCBS corporate director involved in the negotiations. In 2012, the insurance company sought a new contract that led to an impasse, Werner said. Werner said the problem stems from hospital officials dictating how much their reimbursements from Blue Cross will be.

Craig said that is not the case and even in more recent negotiations, hospital leaders have made several offers that were ignored. Hospital officials deny that their rates are exorbitant but note that the hospital's level of care is recognized by the Joint Commission, the leading accreditor of health care organizations in America. The Joint Commission named Wayne Memorial as a top performer on key quality measures. The hospital was one of few in the state to receive the recognition, along with Duke Raleigh Hospital and Rex Hospital, in October.

"There has been a problem from day one of our negotiations in that Blue Cross claims we are a highly paid hospital," Craig said. "Yet, all our data and the independent third-party data available suggest we are a bargain for inpatient services and below the statewide average for outpatient services."

Craig also said that Blue Cross negotiations have been difficult. The most recent breakdown in negotiations was followed by Blue Cross advertisements that claim Wayne Memorial's rates are higher than other hospitals.

"Over the past few weeks, we provided multiple proposals that included significant concessions on our end in an effort to work toward an agreement," Craig said. "Unfortunately, Blue Cross responded three times with essentially the same offer, showing no willingness to compromise.

"It is hard to understand how this is negotiating in the spirit of good faith or partnership, and it certainly is not in the best interest of their members, the many Blue Cross customers who reside in Wayne and surrounding counties."

The hospital remains open to negotiations with BCBS, officials said. Anyone with questions about access to care may call the hospital's Patient Financial Services department at 919-731-6112. Updates are also being provided at www.WeWantWayne.com.

rochelle@wilsontimes.com -- 265-7818

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(c)2013 The Wilson Daily Times (Wilson, N.C.)

Visit The Wilson Daily Times (Wilson, N.C.) at www.wilsontimes.com

Distributed by MCT Information Services

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