SC insurance giant cutting urgent care providers in network

07/08/2014 6:47 PM

07/08/2014 6:48 PM

COLUMBIA, SC BlueCross BlueShield of South Carolina will remove MEDcare Urgent Care from its provider network for some policies in October, prompting the Charleston-based provider to ask the public to speak up in its favor.

MEDcare, which has three facilities in the Midlands, three in the Lowcountry and one in Anderson, started an iPetition campaign this week. By midday Tuesday, more than 350 people had signed the online petition asking BlueCross to reconsider.

“If you believe that access to high quality, affordable urgent care that is convenient is something that should be determined by patients and health care consumers instead of insurance companies, you can support this cause,” said Dr. Radwan S. Hallaba, MEDcare’s CEO.

BlueCross also will knock Nason Medical Center, which has five urgent care facilities in the Lowcountry, out of its network.

In the Midlands, most urgent care facilities will remain in the BlueCross network, including Doctors Care, Doctors Express and the urgent care facilities associated with Lexington Medical Center and Palmetto Health. Also, several groups of BlueCross policies still will treat MEDcare as in-network, including those purchased under the new federal exchange, the State Health Plan and most Medicare or Medigap-related plans.

In some ways, the business decision made by BlueCross is similar to when cable television providers decide not to offer a certain network – except it involves the administration of health care rather than the ability to watch a favorite program.

One twist is that BlueCross BlueShield owns UCI Medical Affiliates, which provides the management support for the Doctors Care chain. Also, BlueCross and its subsidies handle 93 percent of the large group insurance market in South Carolina, according to a study by Kaiser Health in 2012.

“It’s the shot across the bow,” said Sue Berkowitz, director of the S.C. Appleseed Legal Justice Center. “If you don’t play the way we want you to play, we’re going to cut you out.”

BlueCross spokeswoman Patti Embry-Tautenhan said the situation isn’t unprecedented. “Smaller networks are becoming the norm across all specialties,” she said.

Shrinking provider networks were a major factor in last year’s rollout of the federal insurance marketplace policies through the Affordable Care Act. Many people signing up for those policies discovered their family physician or the hospital nearest their home wasn’t in-network. People covered by insurance are free to use out-of-network providers, but they will pay more for those services.

In their Code Blue Bulletin issued in June, BlueCross did offer a comment on the issue: “In the past 10 years, we have seen rapid expansion of South Carolina’s urgent care market, resulting in numerous providers and duplicative services. In response to this trend, we decided to restructure our urgent care network.”

MEDcare said its leaders met with BlueCross executives to discuss the change and were told it wasn’t related to cost, quality, convenience or access. Hallaba, who said MEDcare hasn’t had a rate increase in six years, was left with few reasons to consider.

“It’s harder and harder for me to think one hand doesn’t know what the other is doing,” Hallaba said, referring to BlueCross’ financial interest in Doctors Care’s success. He noted only two privately owned companies were impacted and wondered, “if you’re looking at this as a global thing, is that all you’re doing.”

Hallaba decided to ask the public to join the discussion via the petition because BlueCross BlueShield is technically a mutual company, owned by its members/customers. He hopes many of them will respond, making it easier for him to change some minds when he meets again next week with BlueCross officials.

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