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Mon, Jan. 20

Negotiations stall between health care center and insurance carrier<br>

BCBS members seeking treatment at the WHCC must now pay for their services in full rather than pay a co-payment. Those who pay at the time they are treated receive a “prompt pay discount.” Staff members at the WHCC will submit claims to BCBS on behalf of their patients. BCBS then reimburses the patient directly, said Christman.

The WHCC began examining insurance carriers’ reimbursement fees quite some time ago. The Williams Hospital District Board along with clinic staff held a series of planning sessions in an effort to make the center more profitable. The goal of the board was to reduce tax subsidies, lessening the burden on local taxpayers, while enhancing revenues at the center, she said.

The board was seeking an increase in reimbursement fees from various insurance providers. The first negotiation with another provider was settled quickly, Christman said.

In February, negotiations between the WHCC and BCBS began. The WHCC was seeking an increase in reimbursement fees from a rural fee schedule utilized by BCBS. The fee schedule pays doctors a set amount regardless of what WHCC bills BCBS for services performed, she said.

Prior to negotiations, BCBS was reimbursing the WHCC at a rate of 50 percent of the amount allotted per the rural fee schedule. The WHCC requested a rate of 100 percent of the scheduled amount in March. BCBS refused the request offering to pay at a rate of 80 percent, said Christman.

“Blue Cross Blue Shield presented the Williams Health Care Center a fair and reasonable offer and they refused. We understand the difficulties this has created for our members. Our goal is to help our customers manage rising health care costs,” said Regena Frieben, a public relations manager for BCBS.

When the WHCC later requested a payment rate of 90 percent of the fee schedule, BCBS again refused. Other health care providers in rural areas similar to Williams are being paid at a rate of 90 percent by BCBS, Christman said.

“We are asking only to be paid at the same rate other providers receive,” said Christman.

If BCBS were to pay WHCC at a rate of 90 percent of the rural fee schedule, the average increase in cost to BCBS per patient per visit would be $5 for the most common service offered at the center — an office visit, Christman said.

“We are fully aware of the burden and impact this has had on the approximately 700 Blue Cross Blue Shield customers in our area. However, the clinic must be viable without relying on tax subsidies,” she said. “There’s not a person in this building that doesn’t strive to provide the best health care possible.”

Christman hopes the issue is resolved soon.

“We have not shut the door on this,” she said.

“We are not actively negotiating a contract at this time with the Williams Health Care Center,” said Frieben. “We welcome future negotiations and hope this issue will be resolved.”

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