Blue Cross, Goldsboro hospital in stalemate over costs

Blue Cross says Wayne Memorial Hospital will no longer be part of its hospital network as of Dec. 5, meaning anyone covered through the state's largest insurer will have to pay out-of-network rates for all care aside from emergency treatment.

"Wayne Memorial is the only hospital we got around," Anastacia Sumner, a Blue Cross customer, said Friday. "If we can't go there to get service, then where else are we supposed to go?"

Obtaining in-network rates would mean driving to Wilson or Greenville – or another hospital farther away.

Sumner suffers from diabetes and spent a week in Wayne Memorial in 2011.

"If it happens again and Blue Cross won't take it, that's an $8,000 hospital bill. So, I don't know what else to do with that one," she said.

Blue Cross officials said they have negotiated with Wayne Memorial for more than a year to try to rein in costs, and they said the ongoing stalemate left them with no option but to sever ties with the hospital.

Michelle Douglas, a spokeswoman for the insurer, said Wayne Memorial's prices trend 85 percent higher than comparable hospitals. According to Blue Cross, a hernia repair costs as much as $10,000 at Wayne Memorial and about $3,000 elsewhere, while a colonoscopy is $5,000 at Wayne Memorial versus about $2,000 at other hospitals.

Outpatient services, which account for the bulk of the hospital’s billings, have increased 121 percent over the last 10 years, according to Blue Cross.

"We needed Wayne Memorial to agree to negotiate their price increases with us and not simply implement them and tell us they were doing it. They refused to do that," Douglas said.

Wayne Memorial spokeswoman Georgia Dees said some prices may be higher, but others are lower than other hospitals. She called the dispute a "David versus Goliath" fight against the insurance giant.

"What happens with Wayne Memorial Hospital is just a drop in the bucket to them. Financially for us, it's a matter of survival," Dees said. "Those charges they're giving their customers are not coming here. So, where is it going? Their pocket?"

Dees also accused Blue Cross of creating "a panic" among area residents by announcing in September its decision to terminate the hospital's contract three months later.

"We're not scaring the public. We're being very honest with the public about what's going to happen on Dec. 5," Douglas said.

Both sides said they hope continued negotiations will end the impasse before December, but neither side is budging right now.

In the meantime, Wayne Memorial is distributing fliers to patients with Blue Cross coverage, telling them they can still receive care at the hospital even after Dec. 5 and urging them to lobby Blue Cross officials to keep the Goldsboro hospital in its network. They also have suggested that patients switch to a different insurance provider.