Abusive economy hits health care

After months of debate, Terrebonne General Medical Center (TGMC) and Blue Cross Blue Shield of Louisiana have reached an agreement on what will be handed out by the insurance provider for patient care.

The hospital is considered an in-network partner, which allows patients to avoid out-of-network penalties and additional costs when visiting the facility. Since its inception, TGMC has worked closely with Blue Cross.

While the economy steadily sloped downward, TGMC contended the insurance giant was paying below-market rates for care provided to its members. The argument was “…based on comparisons to regional and national benchmarks,” according to a press release issued by the hospital Friday.

TGMC asked Blue Cross to increase the amount it was paying for patient care, but that initial request was turned down. For the past few months, both parties have been vying to reach an agreement.

“We have a duty; we are owned by our members. We have a duty to negotiate vigorously on their behalf,” said Blue Cross and Blue Shield spokesman John Maginnis.

The new contract between the companies will begin on May 1, 2010.

“We have taken this negotiation extremely seriously, and regret that many in our community had to experience concern over potential loss of Blue Cross coverage for TGMC patients,” said TGMC CEO Phyllis Peoples in the release. “Our obligation to our neighbors, patients and local citizens is to ensure that we have the resources necessary to continue providing quality healthcare close to home.”

With companies across the nation scraping at the bottom of the barrel for funding, the health-care industry appears to be no different. As conditions worsen, the reigns become tighter.

“Insurance companies that demand increased payments from employers and local citizens must keep those funds in our community in the form of fair payment to all providers of healthcare for their members. We treat Blue Cross members fairly, and insurance companies cannot be allowed to pay less than fair payments for the care of our citizens,” explained Peoples.

In a letter written before the compromise was made, Blue Cross alerted customers that it intended to axe Terrebonne General as an in-network facility and the economy was partially to blame.

“Terrebonne General asked for a very large increase in reimbursement rates. During this time of reform and economic downturn, we could not in good conscience agree to this increase, which would inevitably come from the pockets of our members,” said Brian Keller, Blue Cross senior vice president and chief marketing officer, in the correspondence.

More than 26,000 people have Blue Cross in Terrebonne Parish, about 27,000 in Lafourche and nearly 14,000 in St. Mary, according to Maginnis. It’s not clear how many of those people look to TGMC for care.

But for the large number of patients covered by Blue Cross, the change could have been devastating, as many would have been forced to transfer to another institution, or face financial consequences.

Despite the ordeal, it seems both parties’ arms will remain wide open.

“We will continue working with other insurance companies to protect the health, wellness and care of the people of the Tri-parish area,” Peoples noted.

“Terrebonne General is a valued member of our network,” explained Maginnis. “The settlement is a testimony of their willingness to work to lower the cost of health care. This is something recent legislation passed in Washington does not do and all partners in the health-care system have to work together to accomplish it.”