The current market leaders could run into some challengers.
July 13--ANDERSON -- The owner of a recently opened urgent-care medical clinic in Anderson is feuding with the state's top private insurance company.
MEDcare Urgent Care is pressuring BlueCross BlueShield of South Carolina to reverse a decision to remove MEDcare from its network of providers. MEDcare operates six urgent-care clinics across the state, including one near AnMed Health Medical Center on North Fant Street in Anderson.
Dr. Radwan Hallaba, co-founder and chief executive officer of MEDcare, said the "arbitrary decision" by BlueCross BlueShield represents "an unprecedented step toward restricting access, denying patient choice and subjecting patients to fewer options at higher cost."
"We are fighting as advocates for our patients," Hallaba wrote in an email last week. "When an insurance company excludes a physician out of a network, it traps patients, who have to pay higher out-of-network fees to continue to see their provider of choice."
In a bulletin issued last month, BlueCross BlueShield said the restructuring of its urgent-care network is a response to a rapid expansion of South Carolina's urgent-care market. The insurer said that expansion has resulted in duplication among numerous providers.
Seen as a less expensive alternative to hospital emergency rooms, urgent-care providers range from pharmacies that primarily offer flu shots and other vaccinations to larger centers staffed by emergency medical professionals.
"Our decision fits into a national trend of creating smaller provider networks across all medical specialties," said BlueCross BlueShield spokeswoman Patti Embry-Tautenhan.
BlueCross BlueShield provides health insurance for nearly 1 million people in South Carolina, Embry-Tautenhan said.
"Only a very small percentage of our membership will be affected" as a result of the decision by BlueCross BlueShield to remove MEDcare and Nason Medical Center from its provider network, she said. Nason Medical Center has five locations in South Carolina's Lowcountry.
Both companies will remain network providers for people who bought coverage through the federal health-insurance marketplace, as well as for many state employees and those with BlueChoice Medicaid coverage or Medicare and Medigap-related plans.
The MEDcare clinic in Anderson opened in March and treats about 40 patients a day, Hallaba said.
Employees at Bosch, Michelin and those who work for the federal government will need to start paying higher out-of-network fees to go to the MEDcare clinic starting Oct. 8 unless BlueCross BlueShield reverses its recent decision, Hallaba said.
Hallaba said he believes BlueCross BlueShield is removing MEDcare from its provider network to aid Doctors Care, which lists more than 50 locations across South Carolina on its website, including urgent-care clinics in Anderson and Easley.
UCI Medical Associates, which is a wholly owned subsidiary of BlueCross BlueShield, provides nonmedical management and administrative services to Doctors Care.
"It is hard for me to believe that doesn't have something to do with it," Hallaba said in an interview Friday.
According to Hallaba's email, MEDcare charges between 25 percent and 40 percent less than Doctors Care for similar services.
"In 2013 alone, MEDcare saved its patients close to $12 million in cardiac evaluations" compared with what these procedures would have cost at hospital emergency rooms, Hallaba said. He also said MEDcare provided nearly 5,000 free rechecks for patients with elevated blood pressure.
MEDcare guarantees that patients will be seen by board-certified physicians at its clinics, which are open 363 days a year from 9 a.m. to 9 p.m.
"No other statewide urgent care comes close to this level of access and convenience," Hallaba said.
Hallaba is urging patients to sign an online petition calling for BlueCross BlueShield to keep MEDcare in its provider network. The petition had more than 700 signatures as of Saturday.
MEDcare executives met with BlueCross BlueShield officials last week, and Hallaba said they are scheduled to sit down Monday with BlueCross BlueShield of South Carolina President Jim Deyling.
BlueCross BlueShield officials don't expect to change their minds, Embry-Tautenhan said.
"We are committed to moving forward with this decision," she said.
Embry-Tautenhan also emphasized that the BlueCross BlueShield network will continue to have a number of urgent-care providers, including Doctors Care clinics, hospital-based centers and retail-based options such as CVS Minute Clinics.
"Members still have significant choice among urgent-care providers," she said.
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