Blue Cross ex­plains de­ci­sion to drop four ru­ral hos­pi­tals

The Oklahoman - - NEWS - Staff Writer mwingerter@oklahoman.com BY MEG WINGERTER

Blue Cross Blue Shield of Oklahoma said four ru­ral hos­pi­tals leaving its net­work en­gaged in “ques­tion­able” prac­tices that would have in­creased costs for mem­bers.

As of Thurs­day, most Blue Cross plan net­works no longer will in­clude four hos­pi­tals: Drum­right Re­gional Hospi­tal, Fair­fax Com­mu­nity Hospi­tal, Haskell County Com­mu­nity Hospi­tal and Prague Com­mu­nity Hospi­tal.

Pa­tients who have Blue Cross in­sur­ance still could go to the hos­pi­tals, but would be re­spon­si­ble for a larger share of their bill. To avoid pay­ing more, they would have to drive to a hospi­tal that is in net­work.

The rup­ture be­gan when the four hos­pi­tals started per­form­ing lab tests for doc­tors not af­fil­i­ated with them to raise rev­enue. In­sur­ers typ­i­cally pay small hos­pi­tals a higher rate for each test than large labs, be­cause they per­form rel­a­tively few tests and have to cover the over­head costs. When hos­pi­tals per­form more tests at that higher rate, in­sur­ers spend more than they planned.

Blue Cross said in a state­ment that the hos­pi­tals drove up cus­tomers’ costs, be­cause the pa­tient has to pay for a cer­tain per­cent­age of a test’s costs. It es­ti­mated costs at one hospi­tal were more than 50 per­cent higher than some larger labs.

“There is an alarm­ing trend across the na­tion of ques­tion­able billing prac­tices around lab­o­ra­tory test­ing that takes ad­van­tage of ru­ral com­mu­ni­ties,” the Blue Cross state­ment said.

Paul Nus­baum, pres­i­dent of Ru­ral Com­mu­nity Hos­pi­tals of Amer­ica, which owns the four Oklahoma hos­pi­tals, as well as small fa­cil­i­ties in other states, said the hos­pi­tals had of­fered to stop per­form­ing the tests Blue Cross found objectionable, if they could con­tinue their re­la­tion­ship. In­stead, Blue Cross of­fered deep cuts that would have made it fi­nan­cially im­pos­si­ble to serve those cus­tomers, he said.

Blue Cross said in a state­ment that most pa­tients are “se­lec­tive” and go to a provider other than a lo­cal ru­ral hospi­tal. It es­ti­mated pa­tients liv­ing near one ru­ral hospi­tal chose a dif­fer­ent hospi­tal for in­pa­tient care about 94 per­cent of the time, and for out­pa­tient care about 80 per­cent of the time.

“Our claims data shows in­di­vid­u­als shop for health care ser­vices and of­ten are will­ing to drive fur­ther dis­tances for ser­vices,” the state­ment said.

Nus­baum said Blue Cross’ de­ci­sion puts the hos­pi­tals at risk of clos­ing. If hos­pi­tals close, ru­ral com­mu­ni­ties lose their eco­nomic vi­a­bil­ity, he said.

“Ru­ral Ok­la­homans should be out­raged,” he said. “We're fight­ing to keep these fa­cil­i­ties open.”

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