Negotiations are ongoing between BlueCross BlueShield of South Carolina and Carolinas HealthCare System to resolve a pricing issue that has rocked some of the top physician groups in York County and forced thousands of patients to pay more or look for a new provider.
The fallout made nine practices in York, Lancaster and Chesterfield counties out of network for BlueCross BlueShield of South Carolina members on Nov. 22, then for BlueChoice HealthPlan of South Carolina members on Jan. 4. Neither company would estimate when an agreement would be reached, though both apologized to patients caught in the middle.
With most plans, members would face higher charges for services at the uncontracted, out-of-network offices, which include Piedmont GYN/OB, Rock Hill Pediatric Associates and Sanger Heart and Vascular Institute. CHS, a Charlotte-based company, estimates the number of patients affected is more than 30,000.
In a move that has seemed to pacify some patients, the CHS physician groups recently have opened new offices in Charlotte, just across the South Carolina border. Services at the new locations would be considered in-network and billed to BlueCross BlueShield of North Carolina.
The dispute between BlueCross and CHS lies in reimbursement rates.
CHS is asking for an increase to “market-level” rates so that doctors can continue administering quality health care, said hospital system spokeswoman Gail Rosenberg.
BlueCross has offered what they consider “fair” reimbursement rates, holding the line on behalf of members, but those rates have been rejected, said Elizabeth Hammond, insurance company spokeswoman.
“We believe our members will understand that we are working on their behalf to help keep health care costs affordable,” Hammond said. “These are difficult times when businesses and individuals are trying to hold on to their insurance coverage.”
Tom Ayers, 57, an electrical technician at the AbitibiBowater plant in Catawba, sides with BlueCross. After 15 years as a Shiland Family Medicine patient, he plans to see a new physicians’ group for his annual physical in February.
“Shiland is not the only place. If they don’t want to play, I’ll find someone else,” said Ayers, the president of the site’s maintenance local union.
Ayers, who pays about $200 per month for health insurance, doesn’t want to travel to Shiland’s new Steele Creek location.
“It’s not a fix for the problem,” he said.
With about 900 employees, AbitibiBowater is one of the largest York County companies using BlueCross insurance. Other employers include Comporium Communications, the state of South Carolina and York County Natural Gas Authority, which is looking to change insurance carriers.
In an effort to support the community and its doctors, Jim Heckle, the gas authority’s president and CEO, is seeking a new insurance carrier for his 85 employees, most of whom go to at least one of the out-of-network doctors. Requests from The Herald to speak to doctors affected by the fallout were denied by Carolinas HealthCare.
“It makes me mad to pay through the nose for health care insurance and my employees can’t go where they want to. I don’t want my employees to have to go through this,” Heckle said.
Comporium is sticking with BlueCross, said Glenn McFadden, executive vice president and chief operating officer. The Rock Hill-based company estimates that 400 of its 1,000 employees are affected by the fallout and many have changed doctors.
“We are simply caught in the middle,” McFadden said. “We feel that BlueCross BlueShield is negotiating in good faith.”
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