Patients caught in middle of hospital contract dispute

Jan. 20--Joe Kelleher was hoping to have a relaxing New Year's with his family. Instead, he had to scramble to change his business's insurance carrier.

On Dec. 31, Kelleher found out Community Healthcare System and Anthem Blue Cross Blue Shield had failed to reach a new contract, leaving patients with the insurer technically out of network at the system's three Northwest Indiana hospitals. So he had his general manager -- on New Year's Eve -- quickly switch the company's employees to United Healthcare.

"I'm sure these folks in the boardroom are in front of the fireplace having a nice holiday season, while folks with medical issues are concerned about the future," said Kelleher, 45, of Munster, who owns a software development firm in Hammond.

"It's very unfortunate that it comes to these types of negotiations and people's lives and their health are almost being used as pawns."

Patients are caught in the middle of the dispute between Anthem and Community and how much the insurer should pay the hospital system for its services. The two sides were unable to come to an agreement for a new contract for 2016, at a time when the entire health care industry is under pressure to reduce costs.

Community is allowing Anthem patients to keep paying in-network rates through the end of February as it continues negotiating with the insurer, which represents about a third of its patient base. Beyond that, it's unknown what will happen to those currently receiving care at Community Hospital in Munster, St. Catherine Hospital in East Chicago and St. Mary Medical Center in Hobart.

Outpatient physician offices in the Community Care Network are not affected, though the termination could inhibit their ability to provide inpatient services at or refer patients to Community-affiliated hospitals.

Matthew Wellever, a 33-year-old Hegewisch teacher with Blue Cross Blue Shield of Illinois insurance, said his wife is due to give birth at Community Hospital in April, but he's been unable to get clarification on whether they'll be be covered at that time.

"Blue Cross suggested I call the hospital. The hospital puts me back to Blue Cross. They've been putting me back and forth between the two of them," he said. "It's been a nightmare."

Wellever said it's even more distressing because his wife's pregnancy is considered high-risk, so she has to see a doctor at least bi-weekly through her delivery. "Basically we're stuck trying to find a new doctor and hospital to have the baby at," he said. "Had we known ahead of time, we would have found another hospital to start with."

He said they plan to switch to the University of Chicago, but that will mean longer commutes to appointments for his wife and to visits for her family in southern Indiana. "I've always thought Community was a really good health care system. It has soured my opinion of them," he said, adding: "I feel used to help put money in people's pockets."

For its part, Community has stated that Anthem is demanding "significantly" lower rates than their previous contract. The sides continue to talk, and many expect a deal to be reached before March.

"It's just a negotiating ploy between both of them. They're going to see who flinches first," said Jeff Sopko, a Steger insurance broker.

"The ones that are caught in the middle are the members of Anthem and the customers or patients of Community. The ones that suffer are the clients."

But Will Glaros, an employee benefits specialist with Meyers Glaros Group in Schererville, said this is uncharted territory for Northwest Indiana, as it's the first hospital-insurer contract termination he's seen in 37 years of business. "We're all going to learn from this one," he said.

Neither side has clarified whether a patient who is due to give birth or receive ongoing cancer treatment at a Community hospital past February will continue to get the same benefits if the two don't reach an agreement.

A Community spokeswoman referred The Times to a frequently asked-questions section on its website, which says it's "very likely" such a patient will continue to be charged in-network rates after Feb. 29.

"Health plans are required to provide continuation-of-care benefits for a period of time after a network change," the site reads. "Patients should check with their employer and/or Anthem to verify your eligibility for continuation of care." An Anthem spokesman did not respond to requests to provide clarity on the issue.

Many local unions are insured by Anthem Blue Cross Blue Shield. The Operating Engineers Local 150, for instance, has Anthem insurance for its approximately 17,000 members and dependents in northern Indiana. The contract negotiations have many of them concerned.

"These three hospitals provide an important link in health care to the people of Northwest Indiana," said David Fagan, financial secretary for Operating Engineers Local 150.

"If they're unable to resolve the issue, we'd have to encourage members to seek elective services at other facilities still covered by the Anthem PPO network."

Cindy Boyd's husband is in that union; the 57-year-old retired AT&T employee said she's considering switching their care to Franciscan St. Anthony Health in Crown Point. A neighbor, Debbie Bianchi, a 59-year-old retired postal worker with Blue Cross Blue Shield, noted that she's been eyeing a new doctor affiliated with Methodist Hospitals Northlake Campus in Gary.

Kelleher, the small-business owner, lives two blocks from Community Hospital in Munster, and his wife receives breast-cancer treatment from doctors affiliated with the facility. He said the timing of the situation -- he first learned about the dispute around Christmas and had to switch insurers on New Year's Eve -- was perhaps the most unfortunate aspect.

"Nobody likes to talk about greed during the Christmas holiday season. You have these upper-echelon executives that are just greedy. They should be ashamed of themselves," he said, adding: "It's extremely unfortunate that it's gotten to this point."

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