Tahlequah hospital still in BCBS network

Aug. 29--While Blue Cross Blue Shield of Oklahoma remains the sole company offering health insurance policies in the state through the federal exchange, a number of hospitals are falling out of the BCBS network.

A story in the Aug. 23 edition of the Sequoyah County Times reported that BSBS was sending letters to its customers, notifying them that Northeastern Health System Sequoyah, a hospital in Sallisaw, will no longer be part of the Blue Traditional, Blue Choice PPO, Blue Preferred PPO, BlueLincs HMO and Blue Advantage PPO networks.

Reports of the letters raised concern in Tahlequah because the city's hospital is also with Northeastern Health System and is working on its BCBS network contract.

But Jim Berry, executive vice president and hospital administrator, said NHS currently remains within the insurance company's network.

"NHS-Tahlequah still has one main mission: to provide unsurpassed excellence in health care," Berry said. "Because of that, we remain committed to doing what is best for our patients and will continue to work with BCBS to try to secure an agreement that maintains a patient's in-network access to care at NHS-Tahlequah."

At NHS-Sequoyah, being out of network means those covered by BCBS plans will have reduced coverage if they use the hospital. While emergency services are covered, PPO members will receive only out-of-network coverage for non-emergency medical care, and the HMO plan will not cover non-emergency care. Benefit payments will be made directly to policy holders, rather than the hospital. The changes become effective Nov. 29.

Julie Ward, administrator and CEO of NHS-Sequoyah, gave a statement via press release, claiming BCBS was forcing the Sallisaw facility to accept reimbursement rates well below those of other mid-sized hospitals in Oklahoma and Arkansas. She added that BCBS held 70 percent of the health insurance market in Oklahoma, and that hospitals have been having trouble negotiating to stay in-network.

"Fifty-one Oklahoma rural hospitals are currently operating in a negative cash position," Ward said in the release. "Northeastern Health System-Sequoyah cannot accept the rock-bottom rates BCBSOK wants to assign to our hospital. We must cover costs in order to sustain the local quality health care we provide, and add needed new services. We are not asking for anything more than a fair rate consistent with other community hospitals. BCBS is telling its members that they can still access care at similar facilities in surrounding communities. The reality is members tell us they will not seek care at the small hospitals that BCBS is suggesting."

In-network hospitals suggested by BCBS in its letter to policy holders included NHS-Tahlequah, Memorial Hospital of Stilwell, Eastern Oklahoma Medical Center in Poteau, St. Francis Hospital in Muskogee, Latimer County General Hospital and Wagoner Community Hospital.

In recent months, a number of news organizations -- including The Oklahoman, the Journal Record, News 9 KWTV Oklahoma City, and the SCT -- have reported that BCBS has either terminated network contracts or allowed them to expire with Stillwater Medical Center; Integris sites in Oklahoma City, Grove, Miami, Edmond, Yukon and Enid; Fairfax Community Hospital; Drumright Community Hospital; Surgery Center of Oklahoma in Oklahoma City; and Prague Community Hospital.

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