Hospital transition sparks insurance claims

April 06--Transitioning from EASTAR Health System to Saint Francis Hospital Muskogee proved problematic for some patients insured by Blue Cross Blue Shield of Oklahoma.

Problems surfaced after contract negotiations reportedly broke down between the insurer and Saint Francis Health System with regard to reimbursement rates for health care services. BCBS of Oklahoma posted an online alert, notifying its members that two Muskogee hospitals -- and many of the physicians swept into the Saint Francis network -- had been removed from its network of providers for seven plans.

Saint Francis officials issued a statement Wednesday night, saying "in-network services at Saint Francis Muskogee Hospital" remain available to BCBS of Oklahoma members. They declined to elaborate or explain the contradicting statements.

Saint Francis Health System bought EASTAR's east campus and assumed the remainder of a 40-year lease for its main campus, a facility that is owned by a city trust formerly known as Muskogee Regional Medical Center. The acquisition by the Tulsa-based network of hospitals, clinics and physicians was announced in February and finalized Saturday.

BCBS officials, in the online alert that was removed Wednesday following media inquiries, attributed the problems to a decision made by Saint Francis to reject "reimbursement rates previously accepted by EASTAR." That decision resulted with Saint Francis Hospital Muskogee and its physicians being removed from the insurer's network of providers, but the situation began to shift Wednesday.

"At this time, Blue Cross and Blue Shield of Oklahoma is engaged in confidential negotiations with Saint Francis with the intent to protect our members in the Muskogee community," spokeswoman Lauren Cusick said. "We are unable to comment further."

Saint Francis officials acknowledged in their statement that they continued "to be engaged in confidential negotiations" but were "unable to provide additional information at this time." Local health care consumers began sharing concerns after learning they might have to find new primary care providers or travel to hospitals outside Muskogee to secure in-network savings offered by their insurance plans.

Ronnie Ball said he learned about the situation when he went to a scheduled doctor's appointment to get a report from lab work that had been done earlier. Ball, who has coverage through the Blue Cross Medicare Advantage PPO plan, said he learned after he arrived his insurance would not be accepted because his physician was no longer considered an in-network provider as a result of the Saint Francis-EASTAR deal.

"That leaves me ... without a local hospital to go to unless I want to risk paying out-of-network costs or maybe having to pay 100 percent of the costs," Ball said. "I wonder what was behind this decision now that there may be thousands of people in the Muskogee area who no longer have insurance coverage with local doctors or if they do they are out of network."

Cusick was unable to provide information about how many people in the Muskogee area might be affected by Saint Francis' decision if there is no breakthrough in the renewed negotiations. There was some indication, however, the impact could be significant.

Marie Synar, interim director of Muskogee City-County Port Authority's Industrial Development Office, said nine local manufacturers provide health insurance through BCBS plans to more than 600 employees. Employees at five of those companies, she said, provide coverage through BCBS of Oklahoma while the remainder have BCBS plans issued in Illinois, Arkansas and Mississippi.

Cusick was unable to comment about whether local health care consumers insured by plans issued through BCBS companies outside Oklahoma would be affected the same way as those here. She did emphasize the concerns of BCBS members was a primary concern.

Ball lamented the prospect of having to find another primary care physician and all the factors that play into that decision. He described the process as "a health risk," noting a "new doctor doesn't know you like the one who has been treating you for 20 years."

"A lot of doctors don't want to see what another doctor has done -- they want to start all over again, do their own tests," Ball said. "And you are out the cost of all those tests, the blood work -- this is not helping anybody."

Reach D.E. Smoot at (918) 684-2901 or [email protected].

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