Irresponsible Insurance Companies and Hospitals

I received a letter from my insurance provider, Blue Cross Blue Shield (BCBS) Federal, yesterday stating that the local hospital (Mary Washington Hospital) will no longer be accepting BCBS Federal, which is part of BCBS Anthem.

A little background here, BCBS is the second largest healthcare insurance provider in the U.S. and Anthem is the largest group under Anthem. And the area that I live in, Fredericksburg, VA, is what is known as a bedroom community, meaning that many of the residents who live in the area, work somewhere else, and in this case, the most popular employers in the area are the U.S. Federal Government and the U.S. military. The amount of military installations and Government buildings in the area is staggering.

Alright, back to the insurance not being accepted at the local hospital. The good thing about all this is that we have another hospital in the area

This is fairly normal, as this is part of a contract negotiation between the hospital and BCBS Anthem, but it is also very dangerous. In Fredericksburg, we are fortunate to have another hospital, Spotsylvania Regional Medical Center, which opened in 2010. But what if we didn’t have another hospital, where does someone go when they are having an emergency? During an emergency, you are not thinking about insurance, you are thinking about how you or your loved ones can get the emergency care that they need.

It is so irresponsible for the hospital administration and the insurance company to play these games. They are playing with people’s lives, not just money. In the past, when this happened, there would be a month or two that people didn’t have coverage and then they would strike a deal. Somewhere people wearing suits are bickering back and forth over the price of a band-aid. You laugh, but I have been in the ER (Mary Washington actually) and I was given Percocet it was in a sealed package, which was inside a tiny ziplock bag, on the outside of the bag was a barcode and other information needed to control the medication. That information is not only used to keep control of a controlled substance but also used for billing purposes. A quick scan of the barcode and the inventory is reduced by 1 and my chart has the medication added. That information shows up in detailed billing if you request it.

What is happening, is the suits are actually going back and forth over every single item. If a pill cost $100 to purchase and the hospital wants to charge the patient $200 for it, the insurance will say that they will cover $120 for the purchase of the pill. The hospital has several options. 1) Charge the patient the extra $80; 2) Charge the patient $120 for it and don’t make as much money on the pill; 3) negotiate with the insurance for a more fair price. If you ever look at your Explanation of Benefits (EOB) that is sent to you by the insurance company. You will see many times that the doctor or hospital changed only what the insurance company was willing to pay for it. This is very common practice, and I totally understand it. What I find so irresponsible is to allow a lapse where real people will have to deal with it all for a dollar in someone’s pocket.