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Update on Fairview/Blue Cross Tussle

For background see an earlier post:

Fairview Could Leave Blue Cross Network Over Price Tussle.

Jeremy Olson of the Pioneer Press has a nice update:

Tough negotiating between Minnesota's largest health insurer and the state's third-largest health system has patients scrambling to find new doctors and worrying about disruptions to their medical care.

Blue Cross and Fairview have set an Aug. 23 deadline to agree on payment rates for Fairview's doctors and outpatient clinics. (They have until late October to negotiate inpatient hospital rates.) If they can't agree, Blue Cross would pay only out-of-network rates for Fairview care — resulting in much larger bills for patients.

Although leaders on both sides remain hopeful about an agreement, Blue Cross and Fairview have sent letters to affected patients about the impasse. Blue Cross estimates as many as 50,000 of its members have used Fairview clinics or outpatient services in the past year.

Patients wouldn't be prohibited from using Fairview doctors, but some are taking the letters from Blue Cross as a signal to switch. Pregnant women are rescheduling checkups and ultrasounds. Parents are finding new family doctors before the school year and the cold and flu season. Cancer patients are parting with doctors they credit with keeping them alive.

Leaders of Blue Cross and Fairview agree the impasse presents hardships for patients, but are sticking to their positions. Fairview is seeking higher payment rates to improve care, contending its requests are comparable to rates paid by other insurers. Blue Cross counters that Fairview wants payments that far exceed what other health systems receive.

Kori Hennessy, of Minneapolis, chose a family doctor to deliver her second child, partly because she liked the idea of one doctor handling the delivery of her son and his medical care as he grows up. When her family had to switch health plans this summer, she chose Blue Cross because it had an open network that included her doctor.

"So when I got this letter," she said, "I was a little upset."

The first ultrasound to see if she's going to have a boy or girl should be coming up in late August, and O'Hara doesn't know where she will end up. She has used Google and clicked to doctor rating sites online in case she needs a new physician. Although she would like to stay with her doctor, the added co-pays and other costs would be difficult to bear.

"I just can't justify spending so much more money," she said, "no matter how terrible it would be to find somebody new."

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