Those who have medical insurance through Blue Cross Blue Shield of Georgia (BCBSGA) may soon need to visit a hospital other than Spalding Regional Medical Center (SRMC).
The local hospital, on behalf of the Tenet Healthcare Corp., has been in negotiations with BCBSGA for several months, but so far, no agreement has been reached.
The insurance company’s current contract with Spalding Regional will end on June 30, and if the status quo remains, the hospital will be considered out-of-network with the beginning of next month.
As a result, people insured by BCBSGA would either have to visit a hospital that is considered in-network, or they would have to make higher co-payments when they visit Spalding Regional, excluding the facility’s emergency care.
“Today, Blue Cross pays Spalding Regional far less than other private insurance companies, and in these negotiations, they have been unwilling to compromise despite third-party data that validates our position,” wrote SRMC Chief Executive Officer John Quinn in a letter to the Griffin-Spalding Chamber of Commerce.
“These low payment rates are simply not sustainable for us to have the resources we need to invest in quality care for the community,” Quinn wrote.
He added that Spalding Regional had identified a compromise that would have benefited both organizations while keeping costs for employers and employees lower.
“Unfortunately, Blue Cross has refused any further compromise,” he wrote.
The insurance company argues that it has offered and agreed to provide increases in reimbursement for services of all of the Tenet facilities, including Spalding Regional, “but Tenet continues to demand significantly higher rates of increase,” said BCBSGA Director of Public Relations Cheryl Monkhouse in an e-mail after consulting with BCBSGA members involved in the negotiation process.
Asked for a response to Quinn’s statement that BCBSGA pays Spalding Regional far less than other private insurance companies, Monkhouse wrote that “after careful analysis, we confirmed that our current contract reimbursement affords Spalding Regional Medical Center a significant margin.
We made every effort to avoid disruption by working with Spalding on some rate of increase but unfortunately, Tenet was unwilling to accept our proposals and elected to terminate their contract effective 7/1/2010.”
In a phone interview, Quinn said that roughly 10 to 15 percent of patients at Spalding Regional are insured through BCBSGA, as approximately one-third of the hospital’s patients are covered through private insurance — with the remaining two-thirds being on Medicaid, Medicare or without insurance.
“I’m getting phone calls from patients who are quite concerned, and I share their concern,” Quinn said, adding that discussions with BCBSGA will continue in an effort to keep Spalding Regional an in-network provider. “I hope the situation resolves before the end of the month. We’d like to get this thing resolved.”