Thursday, August 24, 2017

Sallisaw Hospital, Insurance Company Part Ways

Sequoyah Memorial Hospital in Sallisaw and BlueCross BlueShield of Oklahoma (BCBSOK) are at odds over costs and reimbursements. The argument has resulted in BCBSOK removing the hospital out of its network, and leaving some insurance holders without a local hospital.

The hospital is notifying patients that Sequoyah Memorial Hospital will no longer be a part of BCBSOK’s network, with the exception of those on Medicare Supplement plans.

The hospital administration argues the hospital is not being reimbursed sufficiently by BCBSOK, but BCBSOK argues the insurance company is trying to manage medical cost increases and provide members with affordable health care.

The contract between Sequoyah Memorial Hospital and BCBSOK ended Aug. 1 but insurance holders have a 120-day transition period, until Nov. 28, to make other insurance or health care arrangements.

Hospital Arguments

In a letter released this week the hospital administration declared, “BCBSOK has been trying to force Sequoyah Memorial (which is now part of Northeastern Health System) to accept rates that are much, much lower than other OK and AR community hospitals. Our research with a third-party analyst has confirmed this. 

The letter says, “We want to remain a participating provider with BCBSOK and have tried negotiating for the past several months. BCBSOK is a powerful insurance company (owned by the highly profitable Chicago-based company Health Care Services Corp.) and BCBSOK holds over 70% of the insurance market share across Oklahoma in many of its products. They dominate the Oklahoma insurance market. This may be why hospitals across OK are having difficulty negotiating with BCBSOK. Many are even making the difficult decision to go out-of-network. 

“Sequoyah Memorial cannot accept the rock-bottom rates BCBSOK wants to assign to our hospital. We must cover our costs in order to sustain the local quality healthcare 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.”

BCBSOK Response

BCBSOK responded, “Our goal throughout the contracting process was to achieve a reasonable outcome that would have allowed us to meet our customers’ and members’ expectations that we manage medical cost increases and provide our members with access to quality, affordable health care. We are disappointed that we were not able to reach a different outcome.”

BCBSOK offered the following information: 
The hospital is no longer a part of BCBSOK’s Blue TraditionalSM, Blue Choice PPOSM, BlueLincs HMO, Blue PreferredSM, and Blue AdvantageSM provider networks. 
BCBSOK members have in-network access to Sequoyah Memorial Hospital through Nov. 28, 2017, because of the 120-day transition period required under our agreements. The transition period allows members to receive care at in-network benefits while they transition their health care to other, in-network facilities. 
Starting Nov. 29, 2017, the following changes will go into effect: 

o PPO members: Nonemergency services at Sequoyah Memorial Hospital facilities will be paid at the out-of-network benefit level. Emergency services will be paid at the in-network level.

o HMO members: Nonemergency services at Sequoyah Memorial Hospital facilities will not be covered. Emergency services will be paid at the in-network level.

o HMO and PPO members: Benefit payments for services at Sequoyah Memorial Hospital will be made directly to the member. Members will then need to pay the hospital for their medical expenses. 
Members on Plan65 Select must use a Plan65 Select participating provider or hospital to receive their full benefits. All other Medicare Supplement plans will not be affected by this change in provider status. 

Members can visit our Provider Finder® to locate a new provider. They can register for or login to Blue Access for MembersSM for personalized search results based on their health plan and network. Members can also call the customer service number on their ID card for assistance. 

The following facilities are in-network alternatives near Sequoyah. For a complete list of alternate facilities, visit our online Provider Finder® tool. 

1401 W Locust St, Stilwell, OK 74960 

105 Wall St, Poteau, OK 74953 

1400 E Downing St. Tahlequah, OK 74464 

2900 N Main, Muskogee, OK 74401 

300 Rockefeller Dr, Muskogee, OK 74401 

806 Highway 2 N, Wilburton, OK 74578 

1200 W Cherokee St, Wagoner, OK 74467 

The BlueCard® Program is a national program that enables members of one Blue Cross and Blue Shield Plan to obtain health care services while traveling or living in another BCBS Plan's service area.

If a Blue Cross and Blue Shield of Oklahoma member has a suitcase on the back of their member ID card, they can go to any provider that participates with the local BCBS plan. If a member has an HMO plan, they must go to a provider that participates with the local HMO plan.

Members may call the customer service number on the back of their ID card for questions or clarification. More information can be found on the BCBSOK website:

Lauren Cusick, BCBSOK media representative, provided the insurance company’s information. 

She wrote, “We understand changing to another facility can be difficult. We are committed to helping members in this process. We are working with doctors in the area to transition our members to other hospitals and facilities in our networks. In addition, we are notifying doctors in our networks of the terminations so they can begin scheduling procedures for our members at other network facilities.”

She continued, “Some health plans may also have continuity of care benefits. This means that if a member is currently being treated for a disability, acute condition, life-threatening illness or pregnancy, they may still be able to see their current doctor at the in-network benefit level, even after their health care provider leaves our networks. Benefits for continuity of care are applied based on the member’s benefit plan. If a member has questions or needs help filling out the continuity of care request form, they may call the customer service number on their ID card. Customer advocates will address their specific questions and help them with submitting a request.”

The hospital’s letter continues, “Sequoyah Memorial strives to provide our community with excellence in healthcare. Because of that, we have been recognized by CMS as a 4 star facility. Sequoyah Memorial cannot understand why BCBS would prefer to pay more for patient care at larger, less convenient facilities. Travel costs will become a burden for our patients. Sequoyah Memorial is not asking BCBS to match the reimbursement at Muskogee or Fort Smith; we are being reasonable and only want fair reimbursement.”

The letter assures residents that the hospital will continue and will help with payments and alternative insurance choices.

The hospital encourages patients to contact BCBSOK.

“YOU can help us by calling BCBSOK at (866)520-2570 and let them know you want to continue having Sequoyah Memorial Hospital available as your in-network provider. This is the single most effective thing we can all do. In addition, talk to your HR or Benefit Manager at your employer and find out what other insurance options you may have that will allow access to our local hospital,” the hospital letter concludes.

Sally Maxwell, Senior News Director

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