Mayor Riley challenges BlueCross BlueShield on urgent care decision

July 21--Public opinion is mounting against BlueCross BlueShield of South Carolina's decision to drop two large urgent care providers from its network later this year.

In a letter to the company last week, Charleston Mayor Joe Riley said the insurer's decision seems "financially self-serving" and "highly detrimental to your independent customers." Riley wrote he believes it limits options and will "clearly increase our health care cost."

"Freedom of choice is always desirable, particularly in health care," Riley said. "I urge you to reconsider the decision."

A spokeswoman for the insurance company said it has received a small number of additional inquiries from customers about this decision.

BlueCross BlueShield of South Carolina, the largest private insurance company in the state, confirmed last month that it will remove both Nason Medical Center and Medcare Urgent Care from its network in October to control rising costs. Nason Medical Center operates five clinics in the Lowcountry. Medcare Urgent Care includes several offices throughout the state.

The decision will affect most BlueCross BlueShield of South Carolina plans. Customers may choose to seek treatment at Nason Medical Center and Medcare Urgent Care after Oct. 8 but will be expected to pay out-of-network prices.

"I think you will see several years of this trend -- of realignment of networks and narrowing, in some areas," said Jim Ritchie, executive director of the S.C. Alliance of Health Plans.

Ritchie had no information about the BlueCross BlueShield decision but said urgent care models are subject to the same market pressures as traditional hospitals and doctors. Insurance companies are becoming more selective in all these sectors. "Urgent care is part of that process," he said.

Dr. Radwan Hallaba, who owns Medcare Urgent Care, met with executives from the BlueCross BlueShield last week. He asked for more information to better understand this decision but was told that the insurance company doesn't share data with providers.

"When you arbitrarily and capriciously, without cause, restrict patient choice and de-select patients from their providers of choice, you restrict quality and innovation and dilute the market forces that drive affordable solutions," Hallaba said.

"When we specifically asked whether or not this decision had anything to do with the fact that they owned Doctors Care, they stated that they did not directly own Doctors Care but only its parent company UCI," he said.

UCI Medical Affiliates, which is owned by BlueCross BlueShield of South Carolina, provides "non-medical management and administrative services" for Doctors Care, according to the company's website. Doctors Care operates one of the largest networks of primary and urgent care medicine in South Carolina.

"There has been a 40 percent increase in urgent care centers since January 2013," said Patti Embry-Tautenhan, a spokeswoman for BlueCross BlueShield of South Carolina. "There are more than 160 urgent care centers in South Carolina at the present time, fewer than one-third of which are Doctors Care centers."

She said the insurance company has explained to Medcare Urgent Care that its costs are outside the norm of other urgent care providers. BlueCross BlueShield is scheduling a site visit at a Medcare clinic and a meeting with Nason Medical Center owners.

"All of our provider contracts are confidential. However, as part of that process we must take into account the total costs of a visit to a provider, including laboratory tests, X-rays and other services," Embry-Tautenhan said. "As an insurer, our constant challenge is finding a way to balance access with affordability for our members. We continuously review what is best for our customers."

An online petition that Hallaba launched on July 4 shows about 1,000 people disagree with BlueCross BlueShield's choice to drop Medcare from its network.

"There is an overwhelming unhappiness with this decision," he said.

Dr. Barron Nason, an owner of Nason Medical Center, said in a prepared statement that the company is focused on treating patients and is working "toward a resolution of all issues which will allow us to carry out our mission."

Reach Lauren Sausser at 937-5598.

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