Catholic Health decries its exclusion from BlueCross Medicare plan

Oct. 29--Catholic Health System is objecting to a Medicare Advantage product offered by BlueCross BlueShield of Western New York that excludes all non-emergency services at Catholic Health hospitals and other sites.

Catholic Health contends BlueCross BlueShield didn't tell the hospital system in advance about its plans for the narrow-network product, Senior Blue HMO Select, and hasn't been up front with its members that nearly all Catholic Health hospital services, as well as home care, laboratory testing, diagnostic imaging and rehabilitation center services, aren't covered in the plan.

"At a time when Catholic Health and Catholic Medical Partners are demonstrating both the value and quality of carefully coordinated care, especially for those with chronic conditions, we are very disappointed to learn of HealthNow's decision to exclude our facilities from their most affordable plan," Joseph McDonald, Catholic Health's president and CEO, said in a statement. HealthNow New York is the parent company of the local BlueCross BlueShield affiliate.

BlueCross BlueShield, however, responds that current and new members are receiving ample notice that the Senior Blue HMO Select plan is a tailored network plan that excludes the Catholic Health system facilities. The insurer said the plan was designed to provide a lower-cost option for Medicare Advantage members, who still may see any doctor or specialist within the Senior Blue network.

"Our Senior Blue Select plan is a cost-effective alternative to a higher-priced, full-choice plan," Julie Snyder, a spokeswoman for the insurer, said in a statement.

The hospitals that are part of the Senior Blue HMO Select plan include Buffalo General Medical Center, Roswell Park Cancer Institute and Erie County Medical Center. Emergency room visits to a Catholic Health hospital will be covered, the insurer said.

Catholic Medical Partners physicians and Mount St. Mary's Hospital in Lewiston also are included in the plan.

Senior Blue HMO Select is one of five BlueCross BlueShield Medicare Advantage plans offered in Erie County for 2015. It replaces the existing Senior Blue 650 Part D plan, which did include the Catholic Health System facilities.

The other four, higher-premium plans offered by BlueCross BlueShield here do include the Catholic Health network.

Someone choosing the narrow network of the Senior Blue HMO Select plan could save $700 in plan premium costs over the course of next year compared to the premium costs of the next-cheapest BlueCross BlueShield Medicare Advantage plan, Senior Blue HMO 651 Part D, according to a comparison of the plans on Medicare.gov.

BlueCross BlueShield has about 48,000 seniors enrolled in its Medicare Advantage plans. Snyder declined to say how many members were enrolled in the Senior Blue 650 Part D plan that is changing to the narrow-network plan.

She pointed out that BlueCross BlueShield offers 17 health insurance plans here, including commercial plans, and only the new Senior Blue HMO Select plan excludes Catholic Health.

The insurer last year did introduce a commercial plan, Align, that is linked to the Kaleida Health hospital network. Under the Align plan, members aren't excluded from Catholic Health hospitals but they do pay more to use them.

In its statement, Catholic Health accused the insurer of "only vaguely communicating" the change to a narrow network and urged members to seek out managed Medicare plans that include its hospitals.

BlueCross BlueShield said the agency that oversees Medicare sets model language for informational materials sent to Medicare Advantage members, and the Centers for Medicare and Medicaid Services have approved all of the insurer's communications.

The insurer went on to say that members who are in the current Senior Blue 650 Part D plan will receive three mailings during the Medicare Advantage enrollment period, which runs through Dec. 7, all of which point out the narrow network.

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