Maryland Hospital Tells Carefirst To Pound Sand (1 Viewer)

[James Daulton]

Fairly big news in my local market, a major Maryland hospital has sent Carefirst a letter notifying them of intent to terminate their contract due to the inability to agree to new terms in a negotiation.

Now in Maryland this normally wouldn't be a huge deal for Carefirst as we have hospitals falling all over themselves, particularly in the city.  Carefirst's customers could easily change out one city hospital for another.  This particular hospital however enjoys a tremendous geographical advantage by being the only hospital located in Annapolis and being very close to both DC and the Eastern Shore.  There is one other hospital about 20 miles away, but it's not known as a quality provider of care.  The hospital in the dispute (Anne Arundel Medical Center) on the flip side is known as a provider of high quality with a large network of primary care and specialist physicians.  The locals of Annapolis love the place and if any provider can successfully tell Carefirst to shove it, this is the one.

I will update as I watch the story play out in the news.

 

[NutterButter]

What's Carefirst?

 

[Charlie Steiner]

Glad I had my cardiac catheterization there before this went down.

 

[James Daulton]

What's Carefirst?

In Maryland it's Blue Cross/Blue Shield.

They have like 70% of the private insurer market in Maryland. 

 

[NutterButter]

In Maryland it's Blue Cross/Blue Shield.

They have like 70% of the private insurer market in Maryland. 

Ah.  I didn't realize that hospital didn't take certain insurance carriers.  So if you're in an accident, your unconscious, the ambulance takes you to this hospital and your insurance is through care first, how does that bill get paid?

 

[Galileo]

Insurance issues popping up everywhere.  In Cleveland, The Cleveland Clinic and CareSource (Ohio's largest Medicaid manager) are on the verge of terminating their contract.  Many folks will either need to switch health care plans or find somewhere other than the Cleveland Clinic for services.

 

[General Malaise]

Hard to envision this one not getting moved to the subforum....

 

[eoMMan]

Sounds like they aren't caring.

 

[NorvilleBarnes]

 So if you're in an accident, your unconscious, the ambulance takes you to this hospital and your insurance is through care first, how does that bill get paid?

CareFist

 

[GregR]

 So if you're in an accident, your unconscious, the ambulance takes you to this hospital and your insurance is through care first, how does that bill get paid?

CareFist

Iron Fist's younger, more empathetic brother.

 

[Christo]

Ah.  I didn't realize that hospital didn't take certain insurance carriers.  So if you're in an accident, your unconscious, the ambulance takes you to this hospital and your insurance is through care first, how does that bill get paid?

I assume it's like most places. They take care of you until you are stable then they ship you to a hospital that takes the insurance. Then the insurance company settles with the hospital.

 

[NutterButter]

CareFist

Is the lube at least covered?

 

[James Daulton]

Is the lube at least covered?

This is serious people!  Of course if you're sick you'll be seen.  It will just cost more with no agreement in place. 

 

[NutterButter]

This is serious people!  Of course if you're sick you'll be seen.  It will just cost more with no agreement in place. 

Lube is always serious.

 

[Bigboy10182000]

Is this a stand alone facility or are they part of a network in MD? If so, which network?

 

[James Daulton]

Is this a stand alone facility or are they part of a network in MD? If so, which network?

They're stand alone.  It's their geography that gives them enough of an advantage where they can stand up to Blue Cross/Blue Shield.

 

[avoiding injuries]

https://www.washingtonpost.com/local/anne-arundel-medical-center-may-drop-carefirst-insurance/2017/07/21/9487cd6a-6dff-11e7-abbc-a53480672286_story.html?utm_term=.7ad077ff2e75

carefirst proposed a .5% decrease in fee payment, aamc supposedly proposed a 6.5% increase in fee payment. they have until sep 30 to come to an agreement. i would guess it gets resolved. 

 

[Uruk-Hai]

Much ado about nothing. They will compromise.

I'm related to someone close to this and she told me it wouldn't really affect normal patient relations, but the side programs could get shut out were it to go sideways (Pathways' addiction help, etc...). 

JD's right that AAMC isn't really affiliated with a higher power (otherwise, they'd never be able to do this), but they have the gonads, talent, and money to make CareFirst sweat a bit.

 

[James Daulton]

https://www.washingtonpost.com/local/anne-arundel-medical-center-may-drop-carefirst-insurance/2017/07/21/9487cd6a-6dff-11e7-abbc-a53480672286_story.html?utm_term=.7ad077ff2e75

carefirst proposed a .5% decrease in fee payment, aamc supposedly proposed a 6.5% increase in fee payment. they have until sep 30 to come to an agreement. i would guess it gets resolved. 

I know people close to the situation and that's not close to true.  Carefirst reduced AAMC's rates significantly and AAMC is asking that they be reset to prior levels.

I do agree that it will get resolved though.  But only because Carefirst actually needs AAMC more than AAMC needs Carefirst.  And the negative reaction from the community would look horrible for Carefirst.