At BlueCross, we provide peace of mind by partnering with providers – doctors, hospitals, outpatient care centers, and others – across the state to keep the cost of health care affordable for our members. This is more important than ever, as health care costs reach record highs and continue to rise amid inflation. And even with these trends, a recent Wall Street Journal investigation showed that hospitals are looking to increase their prices further.
We’ve always balanced choice — lots of providers in our networks — and costs, because both are important to health care consumers. But our customers have told us that their primary concern is rising costs. To deliver the savings our customers need, we are currently negotiating new contracts — or ending contracts — with several provider organizations who are being paid or are requesting higher-than-average rates.
These providers practice at, but aren’t directly employed by, hospitals that participate in our network – think emergency physicians, anesthesiologists, radiologists, and others. We are asking these providers to accept fair market rates that bring them in line with similar providers in our networks.
Our new contract offers would deliver an estimated $65 million in annual savings, which will directly lower our member’s medical costs and help us offset premium increases.
(As we’ve shared, we set premiums each year based on what we expect to pay for the medical services our members need.)
And most importantly, because these providers work in hospitals that do belong to our networks, members won’t have to seek care elsewhere, and they won’t face higher costs. (See below to learn why.)
We value the services these providers offer, and we want to keep them in our networks. Ultimately, it’s our responsibility to help slow the ever-increasing cost of medical services, which drives up the overall cost of care. When providers charge significantly more for the same care, it is difficult to keep coverage affordable for our members.
By modifying our network and seeking new contracts with these providers, we can save tens of millions of dollars to support affordable, high-quality coverage for those we serve.
You may be wondering how we got here.
Over the years, providers in these specialties have often threatened to end their contracts with BlueCross and then balance bill our members to boost their profits. Receiving an out-of-network charge for a visit to an in-network hospital has been one of the most confusing and frustrating experience for our members. So, to protect our members, we have historically responded to balance billing threats by agreeing to higher rates than we wanted to. (To learn more about how surprise billing used to work, click here.)
Now that the law protects our members from balance billing from out-of-network providers who work at in-network facilities, we have a responsibility move these and other outlier providers to fair market rates.
Our goal is to get better pricing on our customer’s behalf, ultimately lowering costs for members.
Members won’t face higher costs
Fortunately, this issue should not impact our members or customers. Under the Consolidated Appropriations Act (CAA), members are legally protected against balance billing, or surprise bills, from out-of-network providers. The CAA prevents these providers from billing our members more than our in-network providers can for the same care and services.
This means that even if you receive care from an out-of-network provider practicing at an in-network facility, your portion of the cost won’t change. The dispute only concerns how much we pay the providers.
We consider this the most effective position we can take to combat the rapidly increasing cost of medical treatment, and we hope these providers will join us in doing what’s right for our members and their patients.