OSF's fight with Blue Cross Blue Shield has people delaying procedures

OSF's fight with Blue Cross Blue Shield has people delaying procedures

URBANA — One woman called off a heart procedure, and her doctor expected another patient to do likewise.

Both patients are covered by Blue Cross Blue Shield of Illinois, and on Feb. 1, they lost in-network coverage for the Urbana and Danville hospitals that became part of Peoria-based OSF HealthCare last week.

Dr. Abraham Kocheril, an Urbana cardiac electrophysiologist now working for OSF's physician group, said one of his Blue Cross Blue Shield patients had been scheduled for a heart arrhythmia procedure on Feb. 2, the day after OSF finalized its purchase of the former Presence Covenant and Presence United Samaritans medical centers. After learning she no longer had in-network coverage, she canceled, he said.

"There is another patient scheduled for a procedure that is in the same boat and will probably cancel," he said.

A heart arrhythmia isn't a life-threatening condition, but it does need to be addressed, Kocheril said.

This week, OSF HealthCare remained in talks with Blue Cross Blue Shield in hope of getting the newly renamed OSF Heart of Mary Medical Center in Urbana and OSF Sacred Heart Medical Center in Danville back in the insurer's provider network, according to OSF spokeswoman Shelli Dankoff.

"Negotiations continue, and we remain hopeful on reaching a positive resolution," she said.

Meanwhile, Blue Cross Blue Shield members don't have in-network coverage at those two hospitals and would be covered at out-of-network rates there. Three Urbana and Danville physicians who were formerly employed by Presence and are now part of OSF Medical Group do remain in network for Blue Cross Blue Shield. They include Kocheril, Dr. Ismail Bobat and Dr. Jomel Labayog.

"We're OK to see them in the office," Kocheril said. "They just can't have procedures done at the hospital. I don't really understand that nuance, since we're all OSF now."

Dankoff said OSF's physician group has a separate contract with Blue Cross Blue Shield that is keeping those Urbana and Danville physicians that have joined OSF in the insurer's provider network.

Keeping the two hospitals out of network, at least for now, are disputed reimbursement rates — how much Blue Cross Blue Shield is willing to pay OSF for services its members receive at the Urbana and Danville hospitals.

OSF and Blue Cross Blue Shield did come to terms late last year for OSF's other Illinois hospitals. But OSF rejected offers to extend rates that had been paid at the Urbana and Danville hospitals under their former owner, Presence Health, according to a Blue Cross Blue Shield notice to brokers.

"OSF instead proposed new terms that would significantly increase cost for our customers," the insurer said.

For its part, OSF has contended Blue Cross Blue Shield has been unwilling to provide reimbursement rates for the Urbana and Danville hospitals that are consistent with what is paid at its other hospitals in similar downstate communities. Nor is the insurer willing to pay rates consistent with those of other insurance payors in Urbana and Danville, the health system said.

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nschne393 wrote on February 07, 2018 at 9:02 am

Merger should not have approved without agreement in place to continue coverage as they do in 10 other OSF hospitals.  Urbana and Danville aren't unique and located in far off places completely foreign to OSF's other locations.