[StBernard] Blue Cross and Franciscans update

[Westley Annis]

Yet in its own way, BC/BS does its own "cost-shifting".  BCBS sez to a
hospital:  We would like you to be a preferred provider for our big group of
people who insure with us.  Here's what we are willing to pay you to admit
those patients.  The hospital will either say yea to get that pool of
insureds or nay because the insurance payments aren't enough.

In 2003 I had to have a surgical procedure done and went to Methodist.  I
had BCBS Federal Plan.  I chose Methodist because it was a PPO hospital with
BCBS and because the doc didn't come to CMC and I needed to be close so
someone could take me and pick me up.  The other hospitals were uptown or in
Jefferson.  After my surgery and after I got home I got a "full"  bill from
Methodist and the cost was amaziing considering I was in there all of 2 and
1/2 days.  But then afterward, I got the "negotiated" bill from Methodist,
i.e. after the agreed upon discounts for being a BCBS PPO.  The difference
was astounding to put it mildly.  

So who paid for that "cost-shift"?  Did Methodist agree to accept less than
what it cost simply to get the BCBS patients in?  Or was the first bill that
overly exaggerated?  Who knows?  When I think back to that, it tells me
there's some b.s.ing going on on both sides in this.

JY





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	another question for the HSD Board, as a rural hospital How Much
will
	Private Insured Patients pay for "Cost Shifting"? {For instance,
Reitz
	criticizes the amount FMOL charges to help pay the
	medical costs not covered by the federal and state plans for the
poor,
	uninsured and elderly. Reitz said that FMOL charges 18 percent while
the
	statewide average is 5 percent in what is called "cost shifting."}
	
	SJK