Bend Memorial Clinic, P.C., reported earlier this month that Regence Blue Cross Blue Shield (BCBS) of Oregon had, “declined an opportunity to contract with BMC under the same terms as all other major insurance companies.” Effective January 1, 2009, BMC will be considered by Regence BCBS to be “out of network.” BMC will offer discounts to members to help offset out-of-pocket expenses for those who remain with Regence BCBS.
“On the one hand, we are surprised by Regence BCBS’s decision. On the other, Regence BCBS recently lost the Bend-La Pine School District contract and we have been told by local insurance brokers that small group members are being given upwards of 30% increases on renewal rates, perhaps forcing many to choose another plan already,” said Marvin J. Lein, CEO.
“We are also aware that Regence BCBS has declined to contract with other physicians in the community. In light of those events, we can’t help but think Regence BCBS may be rethinking its Central Oregon business plan altogether,” stated Lein.
Bend Memorial Clinic includes over 80 physicians representing 15 branches of medicine and 30 service specialties. It is the largest multi-specialty group east of the Cascades and functions as a comprehensive referral center for physicians and communities throughout the state. The Clinic has provided primary and specialty care since 1946.
BMC will continue to serve Regence BCBS insured members on an “out of network” basis and will discount the cost of care to Regence BCBS members on the same basis as if BMC were still in-network. The discount will be 12 percent off all charges.
“We recognize that some Regence BCBS members will need to retain their BCBS coverage for 2009 and so want to do everything possible to reduce their costs in same manner as other patients. By discounting our rates despite not having a contract, we can help these patients continue to see our providers and receive the TotalCare upon which they have come to depend,” said Lein.
BMC will also be making special accommodations to assist members with Blue Cross Blue Shield Medicare coverage.
BMC noted that contracts are in place, or are expected to be renewed, for all other major insurers including ODS Health Plans, Health Net, Providence, ClearChoice, PacificSource, Great West, Coventry/First Health, LifeWise, HealthCare Direct, United Healthcare and Humana among major health plans.
At issue was the need for all insurers to help cover the cost of providing care to Medicare patients, Medicaid patients and the uninsured. “BMC is the only major clinic in all of Central Oregon to accept new Medicare patients and has the largest private Medicare patient panel. Many practices have either closed to these patients or even discharged them from their practices. BMC estimates that it will provide discounts totaling more than $50 million to these community members in 2008 alone, with additional charity care estimated at more than half a million dollars additionally,” said Randal Avolio, BMC chief operating officer.
“We simply cannot turn our backs on these patients. TotalCare means care for all. But in order for us to provide the care these community members need, both BMC and our partner insurance companies respectively need to drive down costs and provide a level of reimbursement that covers these costs,” said Susan Willis, BMC chief financial officer.
Oregon Medicare rates are in the bottom 5 percent of all states when comparing reimbursement for Medicare visits across the U.S.
“Our level-playing field approach asks insurance companies to pay equally for our high-quality services. This partnering approach means we all pitch in equally to ensure members in our community do not go without care. Unfortunately, Regence BCBS’s business plan appears not to allow for its support of these members on that basis,” said Lein. “All other insurance companies have been helping with this challenge for the past several years. We have been most appreciative of their support.
“If Regence BCBS should change its mind, we would be happy to complete an agreement under equal terms.”