Physicians group asks BlueCross to reconsider shrinking urgent care network

07/30/2014 9:22 PM

07/30/2014 9:34 PM

The largest physicians organization in South Carolina wants BlueCross BlueShield of South Carolina to reconsider its plan to boot urgent care groups MEDcare and Nason Medical Care from its network of providers.

BlueCross responded that the S.C. Medical Association isn’t a factor in this business decision.

“Our fundamental obligation is to balance access and cost on behalf of our membership,” according to a statement from BlueCross. “It is always a challenge, and frankly, never more so than today in the midst of an evolving marketplace. Receiving a communication from the Medical Association does not factor into our decision-making. We remain in conversations with both MEDcare and Nason.”

Dr. Radwan Hallaba, one of the owners of Charleston-based MEDcare, said he doesn’t feel like he’s part of the conversation. He thinks BlueCross is using its strength – it handles more than 90 percent of the large group insurance market in the state – to take out competitors of Doctors Care, the urgent care chain managed by BlueCross-owned UCI Medical Affiliates. Doctors Care has 51 offices in the state.

“In every measurable way, they’re guiding patients to Doctors Care,” said Hallaba, who also says Doctors Care gets higher fees than MEDcare for some services from BlueCross. “At our meetings, I said, ‘You’re not giving me a rational explanation.’”

BlueCross has insisted the move is part of a trend of shrinking networks. For instance, many individual hospitals were left out of the thin networks of providers offered in policies on the new federal insurance marketplace. Reducing networks and negotiating better fees with the smaller network of providers brings down cost – to the insurance provider and the insured.

Several groups of BlueCross policies still will treat MEDcare as in-network, including those purchased under the new federal marketplace, the State Health Plan and most Medicare or Medigap-related plans. But many large employer policies though BlueCross will make patients pay much higher out-of-network costs if they go to MEDcare or Nason next year.

Hallaba isn’t letting the change occur without a fight. He started an iPetition drive online for customers to let BlueCross know they don’t approve. He also solicited letters on MEDcare’s behalf from major employers, including Charleston Mayor Joe Riley.

The board of the S.C. Medical Association voted at its July meeting to go to bat for MEDcare. The letter to BlueCross from association president Dr. H. Tim Pearce said “we believe this decision will have a negative effect on patient safety and satisfaction as well as cause disruption within the urgent care marketplace.”

MEDcare has three facilities in the Midlands, three in the Lowcountry and one in Anderson. Nason has five facilities in the Lowcountry. Removing those 12 options for many South Carolinians “increases costs for patients and customers as supply is limited and demand remains high,” Pearce wrote. “This decision also negatively impacts physicians in this state as it unilaterally removes their patients based on a business decision.”

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