WHY LETTER UNNERVED SOME PIEDMONT PATIENTS

Piedmont Hospital might become out of network, insurer says amid talks.

A letter from Blue Cross Blue Shield of Georgia has alarmed

some patients of Piedmont Hospital, telling them the facility may leave the insurance company’s network.

Blue Cross and Piedmont are negotiating over their next contract, and as occasionally happens, the negotiations are going down to the wire. The letter is a standard notice sent when negotiations between a provider and

insurance company for contract renewal get close to the contract date, said Glenn Allen, a spokesman for the Georgia Department of Insurance.

“I’ve seen them go down to the wire like this probably seven times in the last 20 years,” Allen said of the two companies.

This year’s negotiations contain an extra element of tension: As The Atlanta Journal-Constitution reported exclusively earlier this year and last summer, Piedmont Hospital has sued Blue Cross

over what it says is the insurance company’s new practice of deny

ing coverage for some in-hospital MRIs and CAT scans, and for emergency room visits the company claims were unwarranted.

Blue Cross’ parent company, Anthem, told patients its contract with Piedmont Hospital is

set to expire April 1. On that day the hospital will become out of

network to Blue Cross patients, and they would have to pay outof-network fees, which can be much higher.

Hospitals see such letters as a negotiating tactic.

“It would be naive to suggest that Blue Cross is not attempting to influence public opinion,” said Ethan James, the vice president for external affairs at the Georgia Hospital Association.

That doesn’t mean it isn’t hitting home. Gov. Nathan Deal has weighed in, noting that some 577,000 state employees and state university employees and family members are covered under the plans. He responded with his own letter to the two companies’ CEOs telling them to work it out.

“An out of network situation would create an enormous network disruption, especially in the Atlanta and Athens areas, and we will take whatever steps necessary to ensure that our employees can maintain their healthcare providers of choice,” Deal wrote. “While I don’t presume to get in to the specifics of contract negotiations, I do expect these negotiations to be conducted in good faith and around the clock to ensure that there is no disruption” for the patients covered.

Colin Manning, a spokesman for Anthem, wrote in an emailed statement that consumers are the company’s first priority. “We are continuing to negotiate and to reach an agreement that would enable Piedmont to remain part of Blue Cross and Blue Shield of Georgia’s care provider network, limit any disruption to our consumers, and ensure that we are compensating doctors and hospitals fairly,” the statement said.

Insurance companies try to negotiate for lower reimbursements for services to health care providers; and the providers, such as hospitals and doctors, negotiate for higher ones.

To end the relationship would be a problem for either company. Blue Cross needs the customers who sign up for its plans with the intent of being able to go to Piedmont. And Piedmont needs the patients who come there with Blue Cross plans knowing they’ll have the lower, in-network copays.