Blue Cross Blue Shield battles with Piedmont over coverage contr - CBS46 News

Blue Cross Blue Shield battles with Piedmont over coverage contract

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Source: WGCL Source: WGCL
ATLANTA (CBS46) -

Like many patients under the Piedmont Healthcare system, Lynsey Anderson didn’t ask to be sick. But, when she developed kidney stones for the first time in March, she couldn’t avoid surgery.

Now, she’s stuck with medical bills with out of network fees that she can’t afford to pay.

“I had two trips to the hospital; one is from an ambulance,” Anderson said. “All the bloodwork and everything else is going to come separate-- the anesthesiologist bill-- I can’t even factor in how much of a difference it’s going to make,” she says now that her Blue Cross Blue Shield plan is considered “out of network.”

Blue Cross Blue Shield and Piedmont executives have been at an impasse for weeks over the terms of a new contract. The most recent contract expired leaving hundreds of thousands of consumers without full coverage.

“I had no idea that my doctor was in the Piedmont affiliation,” Anderson said. “I was contacted by the doctor’s office, and had I not been, I would’ve had no clue. And, I was contacted two days prior to my surgery.”

She says she’s facing tens of thousands of dollars in charges now that she’s out of network.

“These contract disputes are over money,” said Andy Miller, the editor and CEO of Georgia Health News. “Piedmont wants to be paid ’x,’ and Blue Cross wants to pay them ‘y.’ Blue Cross says they’ve made them a substantial and fair offer. They say it’s three times the inflation rate in terms of an increase,” Miller told CBS46.

Executives from both companies say they’ve been having face-to-face meetings this week, which have helped move negotiations forward. Still, there’s been no deal.

Miller said physician payments is one of the biggest stumbling blocks right now.

“You’ve got to make deals on everything from doctor’s visits all the way to heart surgery,” Miller said.

At the beginning of April Governor Nathan Deal announced he’d be assisting with out-of-network fees for the nearly 600,000 people on state healthcare plans, for 30 days while the companies try to come to terms. Wednesday, Deal’s office told CBS46 they expect it to cost the state $42 million, and not including the University of Georgia system employees.

Governor Deal took to Facebook Wednesay saying in part “I’ve called a meeting between the CEO’s of Piedmont Healthcare and Blue Cross Blue Shield on Monday April 16th. I expect an update on the progress both sides have made in reaching a resolution. Georgia patients deserve stability from their healthcare plans…”

For patients like Anderson who don’t work for the state, the assistance doesn’t help.

“It isn’t fair to the rest of us,” Anderson said. “What are we supposed to do? Why should one group be sectioned out to be covered while the rest of us just have to deal with it?” she questioned, saying the state assistance frustrated her. 

“We pay our premiums every month, and we’re the ones that are suffering,” Anderson added.

Blue Cross Blue Shield of Georgia issued the following statement on the discussions:

 “Blue Cross and Blue Shield of Georgia continues to be actively engaged in negotiations to bring Piedmont’s hospitals and physicians back into our network as soon as possible. Our top priority during these negotiations is to protect consumers’ access to affordable health care.

We share the disappointment of our consumers as many of our own employees who receive care through Piedmont are also affected. Blue Cross and Blue Shield of Georgia has a broad network of high-quality care providers throughout the state, and we are working hard to direct consumers to one of these many providers to limit any disruptions.

Consumers with questions about this network provider change can call the toll-free member services number on the back of their Blue Cross and Blue Shield of Georgia ID card, or visit bcbsga.com to view a list of providers in their area.”

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