October 13, 2013

Some exchange health plans don’t include Hamilton, local doctors

Charles Oliver

— Those who buy some health insurance plans on Georgia’s Obamacare exchange won’t get network access to Hamilton Medical Center and most local doctors.

Network providers have agreed with insurance companies to provide services to exchange customers for certain predetermined rates. If a person covered by the exchange is treated by a doctor or a hospital that is in the plan’s network, the person is generally liable only for whatever co-pay and deductible are called for in the person’s plans. If the person seeks treatment outside the network, the person can be liable for much greater expenses. The big exception to that rule is if the person requires treatment at an out-of-network facility because of an emergency.

In northwest Georgia, only two carriers are selling health insurance plans on the exchange: Blue Cross Blue Shield of Georgia and Alliant Health Plans.

Officials at Alliant say exchange customers will have access to all the doctors and hospitals in their regular network including Hamilton and most local doctors. But Blue Cross Blue Shield officials say exchange customers won’t have access to all the providers in its regular network.

“When we set up the plans we have to make sure they are compliant with the (Patient Protection and Affordable Care Act),” said Blue Cross spokesman Bert Kelly. “One of the first things we have to do is make sure they are affordable and sustainable. We made an offer to everyone who was interested in serving in the exchange, and it was Hamilton’s decision not to participate. For us to remain sustainable over time, we have to set prices at a certain level, and we invited providers to join that network. Some chose to. Some chose not to.”

Jeff Myers, president and CEO of Hamilton Health Care System, said the reimbursement offered by Blue Cross for exchange patients was below what it pays in its other networks.

“It was below cost. It was a take-it-or-leave-it offer,” he said.

Most local doctors have also rejected Blue Cross’ terms to be members of its exchange network.

“They were offering us a huge cut in pay to take part in the exchange,” said David McCreery, president of Physicians Health Services, which represents some 150 doctors in Whitfield and Murray counties.

“It would have been almost impossible for doctors to participate without their local hospital, but we would have declined because of the cut in pay anyway,” he said. “Our doctors will be available through Alliant’s exchange policies but not Blue Cross.”

Hamilton isn’t the only hospital in the region that has declined to join Blue Cross’ health care exchange network.

Floyd Medical Center in Rome, Piedmont Mountainside Hospital in Jasper and Polk Medical Center in Cedartown are not currently in the Blue Cross exchange network, according to Kelly.

Murray Medical Center in Chatsworth, Gordon Hospital in Calhoun, Hutcheson Medical Center in Fort Oglethorpe, Redmond Regional Hospital in Rome and Fannin Regional Hospital in Blue Ridge are among the hospitals that are part of the network.

Kevin Bloye, vice president of public relations for the Georgia Hospital Association, said that group is trying to get information on which hospitals are in the networks for the various plans being sold across the state on the federal exchange.

“We don’t have that information yet,” he said. “We’d love to see it ourselves. We believe that some of our hospitals aren’t sure what networks they are in. Even at this late date, there seems to be more questions than answers. But what we are hearing is that some of these plans are creating very narrow networks. It may be some of them are making volume-based discount deals. They are saying ‘We’ll give you a larger discount if you can steer a large enough volume of business our way.’”

Both Myers and Kelly said Hamilton remains part of Blue Cross’ other networks and those who are covered by a Blue Cross plan that is not part of the federal health care exchange will still have access to Hamilton as part of their network of providers. Most local physicians are also members of Blue Cross’ regular networks.

Kelly notes Blue Cross’ exchange customers can still use Hamilton for emergencies.

“They can still be seen there if there’s an emergency situation, if they are in a car accident or something and have to be treated there,” he said.

Kelly said Blue Cross is constantly reviewing its networks and perhaps the two sides can come to agreement in the future.

“Nothing is permanent, and we’ll see what happens over time,” he said.