PMC, Blue Cross reach deal

Af­ter years of wrang­ing, the hos­pi­tal and the in­sur­ance provider forge an agree­ment with one an­other.

The Standard Journal - - FRONT PAGE - By Kevin Myrick SJ Edi­tor

Af­ter years of those cov­ered by Blue Cross Blue Shield of Ge­or­gia not be­ing cov­ered when they visit Polk Med­i­cal Cen­ter, the par­ent com­pany of the lo­cal hos­pi­tal and in­sur­ance provid- er have come to terms with one an­other.

Floyd Med­i­cal Cen­ter pub­lic re­la­tions of­fi­cials an­nounced the agree­ment reached be­tween Polk Med­i­cal Cen­ter and BCBS on Fri­day af­ter­noon. The deal will go into full ef­fect on May 1, when pa­tient cov­er­age will be­gin of­fi­cially.

“This is good news for those pa­tients in our com­mu­nity who have Blue Cross Blue Shield, “Polk Med­i­cal Cen­ter Ad­min­is­tra­tor Matt Gor­man said in the hos­pi­tal’s press re­lease an- nounc­ing the deal. “This gives peo­ple the abil­ity to ac­cess care lo­cally, which will min­i­mize time they have to spend away from fam­ily and work.”

The re­lease quotes Gor­man as giv­ing credit for help­ing com­plete ne­go­ti­a­tions to State Rep. Trey Kel­ley, R-Cedar­town, who was cru­cial in get­ting the is­sue re­solved.

“Kel­ley helped hos­pi­tal rep­re­sen­ta­tives gain ac­cess to key lead­ers at Blue Cross Blue Shield,” the re­lease stated.

“Rep. Kel­ley has been an ally of ours through­out this en­tire jour­ney,” Gor­man said. “For him, it was as much of an ef­fort on be­half of his own con­stituents as it was for the hos­pi­tal. With­out his sup­port, I don’t know if this is­sue would have gar­nered the at­ten­tion it de­served.”

“He is look­ing out for his com­mu­nity, and he knows it is im­por­tant to ac­cess health care close to home,” Gor­man added.

Kel­ley said he’s ex­cited an agree­ment has been reached.

“This agree­ment will al­low all those pa­tients in our com­mu­nity who have Blue Cross Blue Shield to have ac­cess to their lo­cal hos­pi­tal,” Kel­ley said. “I ap­pre­ci­ate all the ef­forts of Polk Med­i­cal Cen­ter of­fi­cials for get­ting this done. Polk Med­i­cal Cen­ter is a tremen­dous as­set for our com­mu­nity and now even more res­i­dents of our com­mu­nity will get to ben­e­fit from the ser­vices they of­fer.”

The agree­ment be­tween the hos­pi­tal and in­sur­ance provider brings to close a long process of get­ting Blue Cross Blue Shield cus­tomers cov­ered in-net­work when they visit Polk Med­i­cal Cen­ter for treat­ment. Prior to Floyd Health­care Man­age­ment tak­ing over the hos­pi­tal in 2013, HCA Health­care, who owns Red­mond Re­gional Med­i­cal Cen­ter, had re­cently reached a new deal with Blue Cross Blue Shield over re­pay­ments for care.

Ne­go­ti­a­tions be­gan in 2013, and didn’t get far over the past few years as the two sides un­til a law­suit was filed by the hos­pi­tal in 2016 over re­im­burse­ments. At the time, the law­suit claimed that Polk Med­i­cal Cen­ter was get­ting less in pay­ments from BCBS in pur­suit of “re­tal­i­a­tion” for the Cedar­town hos­pi­tal not agree­ing to what they felt were “un­rea­son­able and un­fair terms” to be part of the in­sur­ers net­work of providers.

Gor­man said that law­suit is still work­ing its way through the court sys­tem, and is a sep­a­rate is­sue from the con­tract the hos­pi­tal signed with BCBS. He said ad­di­tion­ally there has been a mis­con­cep­tion about the process of the ne­go­ti­a­tion over the years, that Polk Med­i­cal Cen­ter and the in­sur­ance provider were both try­ing to hold out for the best deal.

“For more than two years we’ve of­fered what we felt were very com­pet­i­tive rates in the ne­go­ti­a­tion, well dis­counted from what Blue Cross Blue Shield is re­ceiv­ing at Floyd Med­i­cal Cen­ter in Rome,” Gor­man said.

Gor­man said he wasn’t at lib­erty to share any de­tails of the agree­ment be­tween the hos­pi­tal and BCBS. “I’m glad that we have a deal,” he said. “In all of these con­tract ne­go­ti­a­tions, both sides usu­ally have to give up some­thing that they wanted.”

‘This agree­ment will al­low all those pa­tients in our com­mu­nity who have Blue Cross Blue Shield to have ac­cess to their lo­cal hos­pi­tal. I ap­pre­ci­ate all the ef­forts of Polk Med­i­cal Cen­ter of­fi­cials for get­ting this done. Polk Med­i­cal Cen­ter is a tremen­dous as­set for our com­mu­nity and now even more res­i­dents of our com­mu­nity will get to ben­e­fit from the ser­vices they of­fer.’

Rep. Trey Kel­ley R-Cedar­town

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