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Blue Cross-Alegent price dispute felt in rural communities, too

Blue Cross-Alegent price dispute felt in rural communities, too

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Some residents of rural Nebraska communities that are home to Catholic Health Initiatives hospitals may have to change doctors or pay higher fees unless two health care giants can reach an agreement.

Blue Cross Blue Shield of Nebraska and CHI Nebraska's hospitals are locked in a dispute over prices charged by CHI Alegent Creighton's hospitals and doctors in the Omaha area.

But CHI hospitals across Nebraska also are affected and could become out-ol-network hospitals tor Blue Cross members unless CHI and Blue Cross settle their differences by the end of August. Out-of-network prices can be hundreds to thousands of dollars more than in-network costs for checkups and procedures.

Physicians in rural Nebraska aren't affected, but their patients who use CHI hospitals could see costs rise for surgeries and other hospital services.

The uncertainty created by the dispute already has affected Sara Kopke.

Kopke, a Hastings resident who teaches in Doniphan, Nebraska, has a back that has required surgeries, and her husband, Rick, has undergone heart procedures. They don't want to find new physicians and hospitals.

"In the eastern part of the state, it might not be such a big issue because you have so many hospitals," said Kopke, 52. "Out here, you don't have a lot of choices."

She considered having a procedure performed this summer on her painful back. The treatment would involve putting a neurotransmitter into her back to diminish chronic

pam and could be done, she said, at CHI's St. Francis Medical Center in Grand Island.

But, Kopke said, she has a metal allergy and the device might have to be pulled out if she has a reaction to it. If complications take place after Aug. 31, she said, she could face out-of-pocket costs that could rise to thousands of dollars.

Kopke said she decided to live with the pain and have the procedure done some other time, when she can count on having most of the costs covered by her insurance plan.

CHI hospitals in Lincoln, Nebraska City, Grand Island, Kearney, Plainview and Schuyler, plus Mercy Hospital in Council Bluffs, are entangled in the dispute.

The disagreement centers on Blue Cross' contention that rates assessed by CHI's Alegent Creighton Health hospitals and affiliated doctors in the Omaha area are too high in comparison with other systems in the metro area — Methodist Health System and the Nebraska Medical Center.

The standoff pits two health care giants against each other: Blue Cross is the primary commercial health insurer in Nebraska and Alegent Creighton controls about half of the metro area's health care market.

Blue Cross executives say they have offered to remove rural CHI hospitals from the argument because their rates in many cases are acceptable.

But CHI officials said that it makes no sense to negotiate separate deals for different CHI hospitals across Nebraska and that rural hospitals should benefit from the same value-and quality-based reimbursement programs that CHI desires for its Omaha-area hospitals.

Blue Cross said there is a non-CHI hospital within 50 miles of 99 percent of its members in rural Nebraska. But those are statistics, said Blue Cross executive Lee Handke, and there is no doubt the situation would create a hardship for some members.

Meanwhile, Blue Cross intends to survey 600 members to see how much they understand about the dispute and to get their opinions.

Peggy Dobish, administrator for the Kearney Clinic, said she has heard from Blue Cross members who want to know, "What are they going to do and is it really going to happen?"

In Kearney, patients have two hospitals to choose from — Kearney Regional Medical Center and CHI's Good Samaritan Hospital. Dobish said she's impartial on which to use, although Good Samaritan has more services than does the new Kearney Regional, including open-heart surgery and the delivery of babies.

Kearney Clinic includes primary-care doctors, surgeons and some physician assistants and nurse practitioners.

"It's the patient who suffers because of the (out-of-network) prices," Dobish said.

For patients with serious, long-term illnesses requiring extensive inpatient care, paying out-of-network rates "would financially ruin most people," said Dan McElligott, president of CHI's St. Francis Medical Center in Grand Island. If CHI and Blue Cross break up, some patients who use St. Francis and other CHI hospitals will have to decide whether they should get new providers who have privileges at other hospitals, McElligott said.

"This is going to be terribly disruptive" to patients with illnesses, he said. "They'd have to figure out where they'd go that they have the same level of trust."

Dr. Deepak Gangahar, a well-known Nebraska heart surgeon who now is president of CHI's Nebraska Heart Hospital in Lincoln, said patients become attached to their physicians and nurses. Jeopardizing that relationship is poor practice on Blue Cross' part, he said.

"This is not a way to conduct business," Gangahar said. "The sad thing is, the one who's caught in the middle is the patient."

Handke, a senior vice president with Blue Cross, said it's with Blue Cross members in mind that the insurer has called out Alegent Creighton on its high prices.

Blue Cross' per member per month cost for Alegent Creighton's UniNet (Alegent Creighton's metro-area hospitals and affiliated doctors) was $430.06 last year, 9.3 percent more than the $393.36 monthly per member claims for the rest of the Blue Cross network across Nebraska, Handke said.

Blue Cross said it will continue in-network coverage beyond Aug. 31 for members with certain conditions, including those receiving cancer treatment, those in their second or third trimester of pregnancy, those being treated for severe kidney disease and some other situations. Blue Cross wants those members to complete an application with their physician and to return it for review by Aug. 31.

Blue Cross spokesman Andy Williams said that if an agreement isn't reached, ambulance service to CHI hospitals will still be covered by Blue Cross, as will emergency treatment and inpatient care related to the emergency, at least for the short term.

The two sides meet weekly and say they hope to reach an agreement.

"It's basically been more of the same," Dr. Cliff Robertson, who heads CHI's Nebraska network, said of recent negotiations. "We are optimistic we can work through this."

But Robertson didn't deny frustration with Blue Cross. "The Blues created this problem," he said.

Handke said, "We won't sign an agreement that's not in the best interests of our members. Obviously they (CHI) are a key system in the state. So it wouldn't be our desire to have a network that doesn't have them in it."

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