Group of independent clinics loses Blue Cross Blue Shield contract

Nov. 16--A Duluth-based network of specialty clinics and primary clinics, located mostly in small towns in Minnesota and Northwestern Wisconsin, will be out of Blue Cross Blue Shield's insurance network as of Feb. 1.

"Blue Cross Blue Shield of Minnesota is cutting off access to good health care providers in order to pad their bottom line," said Jeffrey Tucker, president of Integrity Health Network, during a news conference on Tuesday in the auditorium at the Fitger's Brewery Complex.

Integrity represents more than 200 doctors and providers in 47 clinics and facilities located in 23 communities. Among them are Orthopaedic Associates of Duluth and the Lakewalk Surgery Center in Duluth; the Human Development Center in Duluth and other communities; Raiter Clinic in Cloquet; and the Cromwell Medical Clinic.

Integrity Health handles quality improvements, cost-of-care contracting, health plan and group purchasing negotiations and some "back-office operations" on behalf of all of the providers in its network, Tucker said.

Integrity does not represent Essentia Health or St. Luke's.

The consequences of Blue Cross Blue Shield cutting ties with Integrity will be devastating for her clinic, said Teri Shelton, administrator at the Cromwell Medical Clinic. It serves about 2,000 patients, more than half of whom have some form of Blue Cross coverage, she said.

"From a clinic standpoint, the potential loss of over 50 percent of our patients would be hard to overcome," Shelton said.

It also would be hard on patients, she said, because there's no alternative close to the Cromwell facility -- particularly considering that Raiter Clinic also is part of Integrity. Clinics in Moose Lake and McGregor -- neither of which is part of Integrity -- each are about a 25-minute drive away, she said.

Dr. Kenneth Ripp, who practices at the Raiter Clinic, said the insurer's decision "would be a great hardship for our patients and our community, and it would compromise our practice philosophy. We could see the loss of many patients ... many of whom have multiple problems, who I've been caring for for decades."

Anne Dugan has been Ripp's patient for only two years, but said, "I've been incredibly impressed with the care I've received. It's incredibly efficient. I call, I get responses and I just feel like I'm a person there."

Dugan, who lives on a farm near Wrenshall with her husband and young child and is expecting a second child in February, said she couldn't afford the cost of out-of-network coverage. Although she directs the Duluth Art Institute, making medical appointments in Duluth would be "really, really difficult," Dugan said.

"I'm frankly sad and a little panicked that Blue Cross Blue Shield would ignore rural Minnesota," she said.

In a statement, Blue Cross Blue Shield said it was working to secure separate arrangements with the individual doctors and clinics represented by Integrity Health Network.

"Blue Cross believes that continuing to negotiate rates through a third party is not in the best interest of our members," the insurer said in its statement. "Integrity Health Network is free to continue working with these clinics and doctors as a consultant group, which is standard practice within health insurance."

Shelton wasn't impressed by that argument.

"It's because of the partnership that we have with Integrity Health Network that we're able to provide the high quality of care that we have been providing," she said.

She and Tucker also complained that Blue Cross Blue Shield hadn't updated its website to advise patients of Integrity Health network clinics that they wouldn't be covered after Feb. 1.

"And when you call customer service, Blue Cross Blue Shield representatives are telling their patients that absolutely we're in network for 2017," Shelton said. "But what they're not telling us is that they may only be in network for one month. And at that point, they will not have the opportunity to change their insurance."

The News Tribune was not able to obtain a response from Blue Cross Blue Shield to that contention in time for this story.

Tucker held out hope that there might be a legislative fix for the loss of the Blue Cross Blue Shield contract.

But state Rep. Jennifer Schultz, DFL-Duluth, who was aware of the situation, said there's little, if anything, that state government can do.

State regulations require the insurer to have adequate coverage in the areas they serve, she said. But as long as Blue Cross Blue Shield meets those requirements, there's nothing the Legislature can do to prevent them from dropping providers.

She has met both with the insurer and Integrity, Schultz said, and Blue Cross Blue Shield officials have said Integrity doesn't offer the best value.

"A lot of these folks ... complain about too much government regulation," Schultz said. "And here they're asking: What can the government do? We can't. ... If you want the private markets to work, this is what happens in private markets."

Blue Cross Blue Shield of Minnesota also pulled out of the individual insurance market with MNsure this year.

___

(c)2016 the Duluth News Tribune (Duluth, Minn.)

Visit the Duluth News Tribune (Duluth, Minn.) at www.duluthnewstribune.com

Distributed by Tribune Content Agency, LLC.