As insurers continue launching health plans built around limited networks, some hospitals are fighting back after being excluded from these networks.
Highmark is facing such pushback in a very public forum as Geisinger Health System, based in Danville, Pa., has accused the state’s largest insurer of forcing patients away from its hospitals. Highmark’s Community Blue health plan requires members to pay more for Geisinger’s three hospitals and physician group than other providers, reported the Pittsburgh Tribune-Review.
By Dina Overland
“It’s inappropriate, inconvenient, insensitive and simply wrong to force our neighbors to leave home to seek the care they desperately need,” Geisinger CEO Glenn Steele wrote in a print ad. “It’s bad for you and your family. And it’s bad for central Pennsylvania.”
Community Blue categorizes providers into three cost-based tiers–enhanced, standard and out-of-network. Providers in the standard and out-of-network tiers result in higher copays and other out-of-pocket costs, the Patriot-News reported.
But Steele claimed Highmark’s marketing materials for the Community Blue plan describe Geisinger as less valuable than other providers. “Under the guise of promoting quality and value, it appears that Highmark is penalizing patients who want to obtain advanced and complex medical care locally,” he wrote, according to the Pittsburgh Business Times.
Highmark fought back, explaining its Community Blue plan merely seeks to “give people choice,” Highmark spokesman Leilyn Perri said. What’s more, by designating Geisinger as a standard tier provider, Highmark isn’t attacking its quality of care. “The hospitals deliver excellent care, but they are in the standard tier because they cost more,” he added.
FROM HEALTH CARE EXECUTIVE: “The article on Highmark is very significant. For healthcare costs to recede savings have to start at the hospital level. Here, Highmark is separating expensive hospitals from less expensive hospitals. BC/Mass did the same with Mass General last year by adding to the deductibles of members who used MG. The announcements by BC/Minnesota and BC/Empire regarding their move to reference based reimbursement systems coupled with Wellpoint’s announcement this weekend about not honoring PPO contract payments to doctors is further handwriting on the wall.”
FROM CONSUMER: “Tacit admission that not all contracted providers are paid the same – simply remove the higher cost ones and save clients 25% (according to BCBS of Tx). For example, I had a MRI at XXXXXXXX XXXXX Imaging – billed charges to BCBSTX was $2,400, allowed amount was $1,200. Yet a year later I had the same MRI at XXX XXXXXX (five minutes away) which also is a contracted BCBS provider and the allowed was $350.”