By Jeremy Olson, Pioneer Press, St. Paul, Minn.
Jul. 24–Tough negotiating between Minnesota’s largest health insurer and the state’s third-largest health system has patients scrambling to find new doctors and worrying about disruptions to their medical care.
Jennifer O’Hara searched hard to find the right doctor to deliver her first child and felt comfortable with her choice at the Fairview Riverside Woman’s Clinic in Minneapolis. Now the St. Paul woman is considering a switch in mid-pregnancy because her insurer, Blue Cross and Blue Shield of Minnesota, might drop Fairview doctors from its network.
“To deprive myself and your members of the care we currently receive would be a huge disappointment,” O’Hara wrote Blue Cross in a letter.
Blue Cross and Fairview have set an Aug. 23 deadline to agree on payment rates for Fairview’s doctors and outpatient clinics. (They have until late October to negotiate inpatient hospital rates.) If they can’t agree, Blue Cross would pay only out-of-network rates for Fairview care — resulting in much larger bills for patients.
Although leaders on both sides remain hopeful about an agreement, Blue Cross and Fairview have sent letters to affected patients about the impasse. Blue Cross estimates as many as 50,000 of its members have used Fairview clinics or outpatient services in the past year.
Patients wouldn’t be prohibited from using Fairview doctors, but some are taking the letters from Blue Cross as a signal to switch. Pregnant women are rescheduling checkups and
ultrasounds. Parents are finding new family doctors before the school year and the cold and flu season. Cancer patients are parting with doctors they credit with keeping them alive.
Jeanne, of Minneapolis, summed up her feelings in a posting on the Pioneer Press Web site at twincities.com. She said she has relied on numerous Fairview doctors since she was diagnosed with leukemia in 1993, and the relationship with her primary care doctor is tough to replace.
“She knows how compliant you are about taking drugs or following their advice … She knows why you hate having blood drawn or loves hearing her tell you when she doesn’t know something,” she wrote. “None of these things appears on a medical record, which is the only thing that gets transferred when you go to a new clinic.”
Leaders of Blue Cross and Fairview agree the impasse presents hardships for patients, but are sticking to their positions. Fairview is seeking higher payment rates to improve care, contending its requests are comparable to rates paid by other insurers. Blue Cross counters that Fairview wants payments that far exceed what other health systems receive.
In some cases — such as third-trimester pregnancies or ongoing cancer treatment — Blue Cross may extend coverage so patients may stay with their Fairview doctors. People should call the numbers on their insurance ID cards for more information.
Kori Hennessy, of Minneapolis, chose a family doctor to deliver her second child, partly because she liked the idea of one doctor handling the delivery of her son and his medical care as he grows up. When her family had to switch health plans this summer, she chose Blue Cross because it had an open network that included her doctor.
“So when I got this letter,” she said, “I was a little upset.”
Hennessy has set up her 30- and 32-week appointments with her regular doctor, but scheduled the 34-week visit with a new physician — just in case.
“I’m hoping they have made a decision by then,” she said.
O’Hara deals with contract negotiations in her work, so she understands how the process can linger until the deadline. Still, she is frustrated it is disrupting her first pregnancy, now in its 13th week.
The first ultrasound to see if she’s going to have a boy or girl should be coming up in late August, and O’Hara doesn’t know where she will end up. She has used Google and clicked to doctor rating sites online in case she needs a new physician. Although she would like to stay with her doctor, the added co-pays and other costs would be difficult to bear.
“I just can’t justify spending so much more money,” she said, “no matter how terrible it would be to find somebody new.”
Jeremy Olson can be reached at 651-228-5583.
NEED HELP?
If you’re caught in the Blue Cross-Fairview flap, you can:
–Call Blue Cross and Blue Shield of Minnesota at the numbers on your insurance cards.
–Call Fairview at 612-672-7272.
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Copyright (c) 2008, Pioneer Press, St. Paul, Minn.
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