Wed
Oct 21 2015
05:30 am
Blue Cross drops UTMC hospital and physicians from S network
By: R. Neal

Blue Cross Blue Shield of Tennessee has dropped the University of Tennessee Medical Center and most of its physicians from the BCBS S Network. UTMC is still in the E and P networks. The change is effective March 1, 2016.

If you are in the BCBS S Network this means you could be subject to additional out-of-network charges if you are treated at UTMC.

State of Tennessee employees covered by state BCBS insurance in the S network will still be covered in-network.

Here's an update from UTMC along with a FAQ.

According to the KNS, BCBS signed a five year contract with Tennova to be included in the BCBS S network. UTMC was notified in August that they would be excluded.

Topics:
bizgrrl's picture

I find this confusing. Back

Submitted by bizgrrl on Wed, 2015/10/21 - 6:07am.

I find this confusing. Back in Feb. 2015 when it was first announced in the KNS that Tennova would be added to the BCBS Blue Network S plan, BlueCross Spokeswoman Mary Danielson was quoted as saying:

* The addition of Tennova's three hospitals in the network means every hopsital in Knoxville — including University of Tennessee Medical Center and Covenant Health’s Fort Sanders Regional Medical Center and Parkwest Medical Center — participates in Network S

* Asked about the timing of including Tennova’s hospitals in the network and Danielson said, “We’ve got a growing demand for Blue Network S-based products in Knoxville and across the state where we’re able to provide that choice to members. To better accomodate this growth, we've needed to add facilities to our Network S.

Are UTMC and BC BS TN in negotiations for a contract renewal? Why would BC BS TN not want UTMC in their Network S? Why would UTMC not want to be in BC BS TN's Network S?

Bbeanster's picture

I'm a longtime BCBS policy

Submitted by Bbeanster on Wed, 2015/10/21 - 6:23am.
(in reply to bizgrrl)

I'm a longtime BCBS policy holder, but this is a game changer for me.

I better get on the phone today.

Joe328's picture

My BlueCross ID does not list

Submitted by Joe328 on Wed, 2015/10/21 - 7:22am.

My BlueCross ID does not list the Plan. Just spoke with BlueCross and told my plan is P. Sure hope this is correct.

R. Neal's picture

If you have a card it should

Submitted by R. Neal on Wed, 2015/10/21 - 7:34am.
(in reply to Joe328)

If you have a card it should say on there what network you're in.

Joe328's picture

Network is not listed. BCBS

Submitted by Joe328 on Wed, 2015/10/21 - 7:58am.
(in reply to R. Neal)

Network is not listed. BCBS program is Federal Employee Program with member ID starting with R. The first letter in Member ID use to be the plan network, but that changed several years ago. Using my member ID BCBS said my network is "P." I plan to check further to ensure this is correct. If changes are needed I must decide by the end of December or wait one year.

Somebody's picture

Level I Trauma

Submitted by Somebody on Wed, 2015/10/21 - 9:10am.

What I think ought to be concerning about this is the fact that UTMC is the only Level I Trauma Center in the region (with the exception of Children's Hospital, which obviously isn't set up to serve adult trauma victims).

If you're in a major accident or otherwise sustain a significant injury, the ambulance or helicopter is going to take you to UTMC, without screening you first for your insurance plan. This is a good thing, because it increases your chances for staying alive and recovering. I think either network should cover the initial ER admission, but if you're out-of-network, unless I'm misinformed, it will get more complicated and expensive after that.

Previously, BCBS S-plan customers would be assured that starting out at UTMC wouldn't be a greater financial liability than going to any other ER. Now I've got to wonder. If you start at UTMC ER, are you out-of-network as soon as you go to the ICU, or later to a standard recovery room? What are the health and cost implications of transferring from UTMC ER to an in-network hospital for recovery? That seems like it would be less than ideal on several levels.

Is this the BCBS intent in the first place? ER Trauma admissions and subsequent care are expensive, so move that out-of-network to save some cash? I believe Network S is structured to be less expensive for the consumer on the front end, so do participants skew to lower incomes? Are Network S participants more likely to be admitted through the Trauma Center?

Maybe I'm misinformed about how all of this works, and starting with a trauma admission limits subsequent out-of-network costs. This stuff is always very confusing. Perhaps someone with more knowledge can shed some light.

B Harmon's picture

The rules could have changed

Submitted by B Harmon on Wed, 2015/10/21 - 10:43am.
(in reply to Somebody)

The rules could have changed in the 10 years since I have been actively involved in this, but basically, once a person is considered stabilized and safe to transfer, they need to move to a network hospital. Usually the Care Management (Utilization Review, Case Management, etc) department is to help arrange this having been in contact with the persons insurance carrier to help coordinate what facility will take them and how they will be transferred (non emergency ambulance transfers are generally not covered so this may need to be negotiated if needed).

I would think if a person is in ICU they are not stable enough to transfer. When they are ready to be moved to a general floor, that is when they need to be moved.

The thing that angers me is that this BCBS notification of a change in networks is happening at a time when some open enrollment periods have already ended (Oct 15th) so some may be SOL, not able to change carriers. This is not unusual, since insurance carriers and providers are negotiating their contracts at the same time as open enrollment. This is just stupid. When I was volunteering for the CAC/ AMOS program helping seniors with Medicare, we would call the doctors and they did not know what insurance they would be taking for the next year, even up to the last week of enrollment.

Vicky's picture

The rules could have changed...

Submitted by Vicky (not verified) on Wed, 2015/10/21 - 4:05pm.
(in reply to B Harmon)

And Becky is the best insurance adviser there is. I think she actually has the plans memorized.

She made signing up for the extra plan I needed on top of Medicare far less traumatic than it might have been. CAC people say the same thing about her.

B Harmon's picture

Thank you Vicky. I left the

Submitted by B Harmon on Wed, 2015/10/21 - 4:18pm.
(in reply to Vicky)

Thank you Vicky. I left the program about two years ago. We had a great team and really good "cheat sheets" that made it easier to compare and to give advice. Recently I let go of helping with ACA enrollments to take care of some health concerns.

I spent about a dozen years working in health care insurance for different companies in several capacities. I was glad to leave it all behind.

But I have strayed off the topic of this thread.

TnHiker's picture

Who to Blame? UTMC or BlueCross of TN?

Submitted by TnHiker (not verified) on Tue, 2015/11/03 - 2:45pm.

UTMC's statement about this change sure makes it sound like the contract for BCBS Network S customers was expiring as of 2/29/2016 and that they couldn't come to terms with BCBS of TN for a renewal. Why would I say this? Primarily, go figure why the el Cheapo BCBS Network E is still offering coverage for UTMC. Add to that the fact that UTMC is being very careful to make sure State of TN employees know their coverage is still valid even though they have BCBS Network S.

Sounds to me like a basis for a discrimination lawsuit against UTMC by taking State of TN employees with BCBS Network S but not accepting other patients with BCBS Network S.

I predict they'll come to a deal at the last minute and UTMC will once again accept the BCBS Network S patients.

Up Goose Creek's picture

Reimbursement

Submitted by Up Goose Creek on Fri, 2015/11/06 - 8:53am.

The rates BCBS negotiated UTMC for my ER visit in 2014 were ridiculously low. So not a surprise, but could they have negotiated higher reimbursement? Rates went up in 2015 and again in 2016.

Still can't figure out the network E being included when it offers lower rates. Anyone have a clue?

Does anyone here use network E - how challenging is it to find providers?

R. Neal's picture

We have P, but I checked and

Submitted by R. Neal on Fri, 2015/11/06 - 9:05am.
(in reply to Up Goose Creek)

We have P, but I checked and all our current UTMC docs are in E.

Don't know what future docs we might get referred to, though.

Another problem would be if you need care while traveling. I believe E is mostly local to your major metro area and everything else is out of network.

P network is multi-state, but not sure how that works.

earlnemo's picture

help!

Submitted by earlnemo on Tue, 2015/12/15 - 12:06pm.
(in reply to R. Neal)

So, muddling through which plan to pick this year. 51 year old male, no heath conditions. Apart from needing stitches every 5 or so years, zero spent on health care. I do need to have my inaugural colonoscopy this year, so want to pick a plan that covers cost of that best.

Also, I travel multi-state to work (itinerant carpenterish), thus looking at BCBS P plans. The two P plans I am offered are Siver S09P ($281 mo./$300 deduct./$2000 m.o.p./20% co-pays) and Bronze B01S ($147 mo./$3000 deduct./$6850 m.o.p/ 50% co-pays.

Q: Is the higher priced plan justified because I know I'm going to buy a colonoscopy this year?

The last two years I was on a BCBS E plan, but it reads like those are extremely limited. And S plans are getting dropped locally (although, Healthcare.gov is still telling me S plans are "in network")

ps: any recommendations for a colo doc/butthole surfer?

R. Neal's picture

I think either plan will

Submitted by R. Neal on Tue, 2015/12/15 - 3:09pm.
(in reply to earlnemo)

I think either plan will cover colonoscopy with no copay because it is required coverage under ACA if I'm not mistaken. But I am not an expert so you should confirm with BCBS.

I have also read that if they find something and treat it during the procedure it is no longer "preventive" and some or all could be subject to regular plan copay/deductible. You might want to ask about that, too.

For me, the peace of mind for the P network is worth it. Pretty sure that Bronze plan you mentioned is S network.

Up Goose Creek's picture

Multi-state

Submitted by Up Goose Creek on Fri, 2015/11/06 - 12:11pm.

Network S is multi state as well - glad you brought that up.

You can get travel insurance that will cover you elsewhere but it leave a donut hole for the part of NC that is within 100 miles of my home. Parts of KY as well.

Up Goose Creek's picture

Prices

Submitted by Up Goose Creek on Tue, 2015/12/15 - 1:18pm.

Are those prices before or after your subsidy?

I have the S plan and haven't encountered a problem finding docs. But then only emergency care is in network out of state.

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