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Nemc no longer takes blue cross blue shield insurance!

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  • Nemc no longer takes blue cross blue shield insurance!

    New England Medical Center has announced they will no longer accept Blue Cross Blue Shield health insurance. They cite that the compensation is not adequate. This is very important for so many who have this insurance and have been using the clinic there for years. It seems like a good time to get out and let NEMC know that this is going to impact the ability for many to have access to them (and the great team at the HCM clinic) and maybe lobby BCBS to negotiate further with NEMC on payments. As a resident of Boston who has been a patient of the clinic since its inception, I am one of many who will now have to look for alternatives such as making the trek to Mayo. Please get out your pens and paper, e-mails whatever, and make it known that by refusing this very popular and widely held insurance they are hurting patients and if BCBS does not reimburse to the standard of other insurance companies they need to negotiate with NEMC further!

    Thanks!
    Doug
    NEMC's (Boston) First Myectomy 7-22-2003

  • #2
    Re: Nemc no longer takes blue cross blue shield insurance!

    OH MY... This is very concerning! I will take your lead Doug and do just that and make a call as well. Of course if they think that BC & BS is inadequate compensation, what can they possibly feel about Medicare!!

    I just saw a statement of mine for charges of over $549.00 for a recent visit to the clinic including lab work. Medicare only accepted to pay $183.54 and BC & BS will have to pay 20% of that. Interesting is that my monthly premium on BC & BS actually went down.. that immediately made my head pop up and found me thinking .. what's up with that .. VERY unusual behavior for BC & BS to lower a premium especially in the present economic situation.

    Thanks for the info .. I will also investigate and get writing.

    Pam
    Dx @ 47 with HOCM & HF:11/00
    Guidant ICD:Mar.01, Recalled/replaced:6/05 w/ Medtronic device
    Lead failure,replaced 12/06.
    SF lead recall:07,extracted leads and new device 2012
    [email protected] Tufts, Boston:10/5/03; age 50. ( [email protected] 240 mmHg ++)
    Paroxysmal A-Fib: 06-07,2010 controlled w/sotalol dosing
    Genetic mutation 4/09, mother(d), brother, son, gene+
    Mother of 3, grandma of 3:Tim,27,Sarah,33w/6 y/o old Sophia, 5 y/o Jack, Laura 34, w/ 5 y/o old Benjamin

    Comment


    • #3
      Re: Nemc no longer takes blue cross blue shield insurance!

      I'm not an insurance expert and can barely balance a checkbook (does anyone still do that?), but it seems to me that this a poor financial decision. I mean, BCBS is a very popular plan - I'll guess at least 30%? and if NEMC loses 30% of their business due to this, it just seem foolish.

      Lets hope other organizations get on the bandwagon and let their members know of this important news.
      Marc
      Diagnosed @ 48
      Saw Dr. Michael Debakey @ age 5 - "He's fine, just a little noisy"
      Father to 3 boys 22, 25, 29 (all currently clear - pending genetics)
      AICD - Valentines Day '08, Spark Plug replaced 11/14
      After much research, I had a Myectomy @ Mayo for my 50th Birthday '08
      Quietly going insane . . .

      Comment


      • #4
        Re: Nemc no longer takes blue cross blue shield insurance!

        It seems to me that this will be the first of many. I do medical billing for a living and it is a vicious circle. Dr's charge X amount money for a procedure, the insurance company pays less than requested by following a general amount derived from the profiles of amounts charged by all the doctors in that field (in that area). Then you have Dr's charging more in hopes of raising their "profile". It goes on and on and in reality the only people really getting screwed (pardon my frankness) are us, the paying public. Because let's be honest here, you know as well as I do that the insurance companies and the doctors are making money or they wouldn't be doing it. And who keeps paying? You and me! I guess that's just one reason why we need "socialized" medicine but to be honest, I don't think the government can afford it.

        Ok, I'll follow that diatribe with a question. Is Tuft's NEMC?
        Thanks,
        Barb

        Comment


        • #5
          Re: Nemc no longer takes blue cross blue shield insurance!

          It has been my experience in the past that once negotiations between an insurance company and a medical center reach an impasse. The medical provider will issue such a statement. Patients get upset and start putting pressure on the insurance companies. Then there is an announcement that all is well and the provider will continue to accept the insurance. I have experienced this twice.

          That is not to say that is what will happen here. This is just my personal experience. Hopefully, everything will work out.
          Annette w/Zapper, Zipper & Ticker
          Symptomatic 1987, Diagnosed 1999, AICD 2001, 2005
          Myectomy w/valve replacement 8/2007 (36 y/o)

          Comment


          • #6
            Re: Nemc no longer takes blue cross blue shield insurance!

            This is NOT correct - yet. TUFT's is still taking Blue Cross and Blue Shield - the hospital has a contract in place through the end of 2009. What is happening is the doctors are negotiating their contract with Blue Cross and Blue Shield and their contract ends on January 31, 2009. They are still negotiating... here is what you can do.
            1. Call or email BC/BS at 800-262-2583 or [email protected]
            2. Call TUFTS at 800-9-KEEPMD

            Tell them how important it is for you to continue your care with your doctor!! Encourage them to reach a settlement SOON!

            Uff da!
            Lisa
            Last edited by kelly; 01-07-2009, 02:16 PM.
            Knowledge is power ... Stay informed!
            YOU can make a difference - all you have to do is try!

            Dx age 12 current age 46 and counting!
            lost: 5 family members to HCM (SCD, Stroke, CHF)
            Others diagnosed living with HCM (or gene +) include - daughter, niece, nephew, cousin, sister and many many friends!
            Therapy - ICD (implanted 97, 01, 04 and 11, medication
            Currently not obstructed
            Complications - unnecessary pacemaker and stroke (unrelated to each other)

            Comment


            • #7
              Re: Nemc no longer takes blue cross blue shield insurance!

              I do hope this turns out to be the case. The news actually reported very matter of factly that "New England Medical Center" (no mention of Tufts) announced last night they will no longer accept BCBS after January 31. It was left at that, nothing about negotiations...
              NEMC's (Boston) First Myectomy 7-22-2003

              Comment


              • #8
                Re: Nemc no longer takes blue cross blue shield insurance!

                Yes Tufts is the new name formerly called NEMC.

                I saw it too Doug.. it was all very matter of fact and sounded cut and dry on the 12 noon Boston WBZ news.

                Tufts Medical Center to drop Blue Cross coverage
                By Associated Press | Monday, January 5, 2009 | http://www.bostonherald.com | Healthcare
                BOSTON — Tufts Medical Center is informing patients that the hospital’s doctors will no longer accept Blue Cross Blue Shield HMO coverage after Jan. 31 because the insurer refuses to pay Tufts doctors at a "reasonable rate."

                Tufts officials tell The Boston Globe they had no choice but to begin phasing out Blue Cross coverage after 11 months of failed negotiations with the state’s largest insurer.

                Hospital executive director Ellen Zane says Blue Cross pays Tufts doctors 20 to 40 percent less than other major teaching hospitals.

                A spokesman for Blue Cross Blue Shield of Massachusetts called the move a "negotiating tactic" that imperils patients. Jay McQuaide says Blue Cross offered Tufts increases similar to other hospitals and physicians groups, but Tufts wants more.

                Here is the link to the news feed:

                http://www.necn.com/Boston/Health/20...231249132.html

                Article URL: http://www.bostonherald.com/business...icleid=1143409

                This article:

                http://www.boston.com/news/health/ar...th_blue_cross/

                says Ellen Zane has used this negotiating tactic in negotiations at other facilities and it has worked...here's hoping,
                Dx @ 47 with HOCM & HF:11/00
                Guidant ICD:Mar.01, Recalled/replaced:6/05 w/ Medtronic device
                Lead failure,replaced 12/06.
                SF lead recall:07,extracted leads and new device 2012
                [email protected] Tufts, Boston:10/5/03; age 50. ( [email protected] 240 mmHg ++)
                Paroxysmal A-Fib: 06-07,2010 controlled w/sotalol dosing
                Genetic mutation 4/09, mother(d), brother, son, gene+
                Mother of 3, grandma of 3:Tim,27,Sarah,33w/6 y/o old Sophia, 5 y/o Jack, Laura 34, w/ 5 y/o old Benjamin

                Comment


                • #9
                  Re: Nemc no longer takes blue cross blue shield insurance!

                  I knew it was always Tufts-NEMC, but didn't know they dropped the NEMC. The news I heard (WBZ) actually reported it as NEMC, no mention of Tufts.

                  Not surprising since I work for the "other" major hospital...Massachusetts General/Harvard/Brigham and Womens/Partners/whoeverelsetheycanthinkof!
                  NEMC's (Boston) First Myectomy 7-22-2003

                  Comment


                  • #10
                    Re: Nemc no longer takes blue cross blue shield insurance!

                    Yes Doug it was formally changed this year.. an interesting aside about the competitor hospitals that you mention.. my daughter works for them also at North Shore Medical.. The partners MGH and B&W are about to open; soon a multi million dollar facility at Patriot Place; aka Gillette Stadium and has the local hospitals all churned up. Their ( the partners) survey states that there are 30-40,000 patients that they service in the Nepponset Valley area which led them to building a new hospital in Foxboro, Ma.

                    One thing seems sure... big hospitals will go to great lengths in times of an iffy economy to capture patient populations and their business.. It seems rather coincidental that the local hospitals are screaming in a recent news report on Sunday.. loudly at the costs charged by Partners hospitals and it seems that per some of these articles today that they get reimbursed at a higher .. much higher rate then many hospitals in Massachusetts.
                    Dx @ 47 with HOCM & HF:11/00
                    Guidant ICD:Mar.01, Recalled/replaced:6/05 w/ Medtronic device
                    Lead failure,replaced 12/06.
                    SF lead recall:07,extracted leads and new device 2012
                    [email protected] Tufts, Boston:10/5/03; age 50. ( [email protected] 240 mmHg ++)
                    Paroxysmal A-Fib: 06-07,2010 controlled w/sotalol dosing
                    Genetic mutation 4/09, mother(d), brother, son, gene+
                    Mother of 3, grandma of 3:Tim,27,Sarah,33w/6 y/o old Sophia, 5 y/o Jack, Laura 34, w/ 5 y/o old Benjamin

                    Comment


                    • #11
                      Re: Nemc no longer takes blue cross blue shield insurance!

                      I just wanted to comment that the exact same thing happened here in Los Angeles with UCLA hospital and doctors and Blue Shield, of which I am a member. It has happened twice, and both times it wound up being a substantial period of time where UCLA would not accept Blue Shield insurance, and you could only go there if you used out of network benefits. Both times they did end up resolving the situation, but it took a couple of months the first time, and close to a year the second time.
                      Daughter of Father with HCM
                      Diagnosed with HCM 1999.
                      Full term pregnancy - Son born 11/01
                      ICD implanted 2/03; generator replaced 2/2005 and 2/2012
                      Myectomy 8/11/06 - Joe Dearani - Mayo Clinic.

                      Comment


                      • #12
                        Re: Nemc no longer takes blue cross blue shield insurance!

                        Originally posted by Lisa Salberg View Post
                        ... here is what you can do.
                        1. Call or email BC/BS at 800-262-2583 or [email protected]
                        2. Call TUFTS at 800-9-KEEPMD

                        Tell them how important it is for you to continue your care with your doctor!! Encourage them to reach a settlement SOON!

                        Uff da!
                        Lisa
                        I've posted it to our blog. I'll be writing to BC/BS of MA as well.
                        http://icdusergroup.com/2009/01/hcm-...ross-blue.html
                        --
                        HCM patient on a quest for access to the data collected by my implantable electronic cardiac defibrillator. Diagnosed with HCM with obstruction in October 2006, at age 40. Estimated LVOT gradient of 10-23 mmHg at rest, 147 mmHg with exercise. Passionate about connected health. Join me on my quest.

                        On TEDx: http://bit.ly/ICDdata
                        On Twitter: http://twitter.com/hugooc
                        --

                        Comment


                        • #13
                          Re: Nemc no longer takes blue cross blue shield insurance!

                          This would affect us too and is very distressing. I have sent emails to friends all over New England to email MABCBS. I hope it helps. Bob also wrote to our BCBS account executive in Western NY and they said they will forward our letter to their BCBS Association contact to pass along our concerns. Those of us with BCBS plans should contact our plan supervisors and let them know that this will affect us and ask for them to forward our concerns promptly to MABCBS.

                          I think for many BCBS customers with PPO plans, this will just cost BCBS more money if they drop Tufts, because people like us will go to other Boston or New England hospitals that cost even more than Tufts. I hope this resolves favorably.

                          Lisa, please let us know if there is anything else we can do.

                          Comment


                          • #14
                            Re: Nemc no longer takes blue cross blue shield insurance!

                            I received a letter in the mail yesterday regarding this! It made me ill just thinking what if I can no longer continue to see my wonderful doctors at Tufts?! My employer only offers Blue Cross/Blue Shield of Mass...(different tiers). I have already sent 2 grievence emails to BCBS. A personal note and a lengthy business like note. I strongly hope they come to an agreement soon.
                            \"It is not length of life, but depth of life.\"

                            Ralph Waldo Emerson

                            Comment


                            • #15
                              Re: Nemc no longer takes blue cross blue shield insurance!

                              Sent my email.

                              This issue doesn't effect my health coverage in the slightest, but it effects many of my friends here on this board so I feel it is important that we all support them. It only takes a minute to copy, paste, edit, and send one of the emails Lisa posted so please let's everybody take a minute to do this:

                              Call to action!!!

                              You do not need to be a Tufts/NEMC patient or BC/BS member to help out.

                              Lisa has provided sample emails for both.

                              Jim
                              "Some days you're the dog... some days you're the hydrant."

                              Comment

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