BlueCross BlueShield of S.C. backtracks on Nason Medical Center decision

By Ashley Barker
abarker@scbiznews.com
Published August 4, 2014

About a month after announcing that it would remove Nason Medical Center from its network later this year, BlueCross BlueShield of South Carolina has reversed course.

BlueCross and BlueChoice members will continue to have access to the Lowcountry-based urgent care centers at in-network rates.

Both companies reached an agreement to “address cost concerns,” according to Jim Deyling, president of the private business division of BlueCross.

“We have been on the record as saying that our fundamental obligation is to balance access and cost on behalf of our membership,” Deyling said in a statement. “It is always a challenge, and today’s evolving health care environment makes fulfilling that obligation even more complicated.”

In June, BlueCross announced that Nason’s clinics on James Island and in Mount Pleasant, North Charleston and Summerville would be excluded from its network beginning Oct. 8.

Dr. Barron Nason, chief medical officer and co-founder of the medical center, said he is pleased the company will continue to be in-network for BlueCross customers.

“We have found BlueCross to be honest and fair in our discussions,” Nason said in a statement issued through BlueCross.

MedCare still excluded

BlueCross is still set to drop MedCare Urgent Care from its network in the fall. MedCare has locations in North Charleston, West Ashley, Columbia, West Columbia and Anderson.

Patti Embry-Tautenhan, a spokeswoman for BlueCross BlueShield of S.C., said the companies are still discussing the situation and the details of a contract are proprietary. She added that the signed contract with Nason was reached because Nason leaders “understood the data” related to the rising costs of health care.

“We look forward to having some meaningful conversations,” she said.

Kelly Moore, physician liaison and outreach coordinator for MedCare Urgent Care Center, said BlueCross representatives told her that the decision to de-select them was “unrelated to any cost metrics, quality metrics or access measures.”

Moore said she believes the decision was made because of Doctors Care expansions, including one in Mount Pleasant. Doctors Care is operated by Columbia-based UCI Medical Affiliates, a subsidiary of BlueCross BlueShield of South Carolina. UCI provides back-office support for the Doctors Care chain.

Moore doesn’t appear to be alone in her belief.

Letters pour in

Charleston Mayor Joe Riley, the president of the S.C. Medical Association and a Teamsters union representative have all recently written letters pertaining to BlueCross’ urgent care decision.

On July 17, Riley wrote (.pdf) that dropping the urgent care providers would have an impact on his employees’ satisfaction with their health care options and would “clearly increase our health care cost.”

“Our practice has been to promote the utilization of urgent care centers as an alternative to more expensive hospital emergency rooms, and our data supports that our efforts have been successful. Limiting our employees’ choice of providers, we believe, will have the result of employees choosing more expensive care and will impact our health care budget,” Riley wrote to Michael Harris, vice president of major group sales at BlueCross BlueShield of S.C.

He went on to say BlueCross’ financial interest in Doctors Care is a concern.

“The decision to limit access to many other urgent care providers with little or no justification given by BCBS seems to be a decision that is financially self-serving to BCBS and highly detrimental to your independent customers,” Riley wrote. “Freedom of choice is always desirable, particularly in healthcare. I urge you to reconsider the decision.”

Dr. H. Tim Pearce, president of the state’s medical association, wrote directly (.pdf) to Deyling on July 28 with his concerns.

“This decision creates a chasm between the patient and their preferred physician at the exact moment that a patient, in an emergency or urgent situation, is seeking the valuable services of their trusted physician,” Pearce wrote. “As a result, the patient must pay a higher than normal fee and bear the burden of added stress in order to maintain that valued and trusted relationship. We believe that this represents too high of a cost for patients in South Carolina.”

He said removing the urgent care centers would also negatively impact physicians in the state by indirectly driving them out of the practice of medicine.

James Todd, a business agent and trustee of Local 509 of the Teamsters union, wrote a letter (.pdf) to the Central States, Southeast and Southwest Areas, Health and Welfare Plan asking that it help change BlueCross’ mind.

The union represents about 1.4 million members nationwide, consisting of UPS drivers, warehouse workers, public defenders, health care professionals and many other occupations. Todd said members are outraged about the “chaotic BCBS decision.”

“Particularly, our UPS members are mad as hell. UPS employees work long, hard hours and (have) an extremely difficult time getting a day off from work even when they are sick. With this in mind, the UPS employees often use various urgent care facilities that work within their schedules,” Todd wrote.

He said now is not the time to drop medical providers with the population growing rapidly, and particularly with the number of baby boomers reaching retirement age.

“Now is the time to expand and grow the network so the members that live in an extremely fast world can choose and receive medical attention on their own schedule and by the health care provider of their choice,” Todd wrote.

Embry-Tautenhan of BlueCross said the health insurance company received and reviewed the three letters and a representative spoke directly to Riley.

She did not respond to questions about the future of MedCare in the network other than to say it is still scheduled to exit on Oct. 8 and discussions are continuing.

“We were very pleased to work with Nason. Nason understood what the issue was, so we were able to negotiate with Nason,” Embry-Tautenhan said. “The content of our conversation is with the providers. The issue was discussed with the providers. That’s really what the heart of our conversation is about.”

Reach staff writer Ashley Barker at 843-849-3144 or @AshleyNBarker on Twitter.

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