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Goldsboro hospital discharged from Blue Cross network

Posted December 5, 2013

— Blue Cross Blue Shield of North Carolina has booted Wayne Memorial Hospital in Goldsboro out of its provider network after a protracted contract dispute, both sides said Thursday.

Effective Thursday, anyone covered through the state's largest insurer will have to pay out-of-network rates for all care at Wayne Memorial aside from emergency treatment. Patients with Blue Cross Medicare Advantage, including Blue Cross secondary or supplemental plans, also aren't affected by the hospital's out-of-network status.

Blue Cross Vice President of Network Management Lisa Cade said the company has negotiated with Wayne Memorial for 18 months to try to rein in costs, and the ongoing stalemate left them with no option but to sever ties with the hospital.

Wayne Memorial's prices trend 85 percent higher than comparable hospitals, the insurer has said, and outpatient services, which account for the bulk of the hospital’s billings, had increased 121 percent over the last 10 years.

"We regret that the hospital’s executives and Board chose to reject our proposal rather than agreeing to reasonable terms that would have helped Wayne County families afford their care," Cade said in a statement. "At the end of the day, Wayne Memorial’s best offer demanded that our customers pay guaranteed annual increases higher than any other hospital in the state on prices for outpatient services that are already far in excess of the statewide average."

Wayne Memorial President and Chief Executive Bill Paugh said the hospital made concessions on each of Blue Cross' demands, but "it was never enough."

“This is not the outcome we wanted, but accepting Blue Cross’ offer meant reductions in our services and an impact to our staff," Paugh said in a statement. "That’s not in the best interest of our patients or our community. As a responsible community hospital, we simply can’t accept a contract that would have such a negative impact.”

Hospital officials said they would work to keep most patients' out-of-pocket costs at in-network levels through the end of March.

“We don’t want to put our patients in the middle of this situation,” hospital chairman Dr. Christopher Griffin said in a statement. “They shouldn’t be forced to pay higher out-of-pocket costs, drive out of the area to receive care or delay necessary treatment out of concern for costs. While this isn’t a long-term solution and it is going to be a challenging process, we will do our best to protect our patients from any unnecessary burdens."

Blue Cross will inform its customers of in-network options for their hospital services, Cade said.

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  • 20K Dec 9, 6:43 p.m.

    People around Goldsboro can thank Obamacare for this!!!!!!!! To anyone that says it is not I say Oh yes it is a result of Obamacare!!!

  • JMM1 Dec 6, 10:33 a.m.

    @chuckyoung

    I've been a Conservative Republican all my life. But I do have to wonder what is your solution for children who have parents with low IQ's and simply may be bad parents and don't make much money. Should these children starve and not receive health care? I'm just guessing from your post that you are also Pro-Life. Should these children that you wanted born just be forgotten by our society because they have irresponsible parents? What is your solution?

  • seapeeay Dec 6, 10:14 a.m.

    I recently had surgery at Wayne. Out patient surgery. Total time in the hospital including waiting for 2 hours was 6 hours. I now owe the hospital $4,609 OUT OF POCKET. I have BCBS with a $5,000 deductible. Seems like I got what I paid for from BCBS.

    Wayne Hospital will give me a 20% credit if I pay within 30 days. They offered me a 22% credit if I paid when I entered the hospital and paid before the procedure. Now why is that? I know of many people that make monthly payments to the hospital. Why do they offer such large credits for immediate payments? That's crazy.

    The admissions clerk told me that BCBS should be ashamed not to cover WMH because so many Wayne Co residents have BCBS. Should WMH not be ashamed to charge so much more for services?

    If these other hospitals can work with BCBS, why can't Wayne?

  • happymom Dec 5, 7:59 p.m.

    ""WHY are Wayne Memorial rates out of the norm...? leafan"

    Because the Goldsboro area is mostly populated by uninsured, government subsidized citizens and those few that do go there must pay extremely inflated prices to cover those who use emergency rooms as their family doctor....."
    -------------------------------------------------

    Wrong. Medicaid is covering those costs, along with state funded indigent care. And there's no evidence that Goldsboro is an outlier in indigent or Medicaid covered care.

  • happymom Dec 5, 7:56 p.m.

    "What he said:" "They shouldn’t be forced to pay higher out-of-pocket costs," What he meant " Thanks Obamacare."

    lolxxxooo

    ------------------------------------------------------------
    ----

    Obamacare has absolutely NOTHING to do with this. This is a private insurer having a direct dispute with a hospital. Things like this happened long before Obama was ever even a senator, much less the President.

    Believe it or not, not everything that ails healthcare is Obama's fault.

  • soapbox Dec 5, 7:35 p.m.

    ...PLEASE produce the evidence that BCBS has 'squirreled away BILLIONS' - exteacher

    In 2010, Consumers Union issued a report on BCBS showing that they stockpiled way more surplus than was deemed necessary. The surpluses ran into hundreds of millions.

    "Insurers must keep surplus money to ensure they can pay policyholders' medical bills if unexpected market conditions develop. Yet 7 of the [10] plans examined held more than three times the amount regulators consider the minimum needed to do that, according to a report being released today by the non-profit consumer group."

    http://usatoday30.usatoday.com/MONEY/INDUSTRIES/INSURANCE/2010-07-22-INSURERS_N.HTM

    In an effort to curb this sort of excess, the ACA contains the "80/20 rule" (effective 2011) whereby 80% of subscriber premium $$ must be spent on healthcare, leaving 20% for administrative costs and profits to investors.

    http://www.washingtonpost.com/blogs/wonkblog/wp/2013/07/18/the-obamacare-provision-that-terrifies-insurers/

  • liveurownlifepeople Dec 5, 7:21 p.m.

    exteacher: "BCBS is looking out for its customers by refusing to pay the exorbitant prices"
    Laughable, BCBS themselves are the ones that charge Exorbitant Rates, Then Want a rate increase or 26 % for the exact same policy on Jan. 1st as they just cancelled on you Dec. 31st.( not too forget the attempt that got delayed for 12 months that will make your rate 3 times the old one for less coverage)

  • whoami Dec 5, 7:18 p.m.

    estrauch - take off your ObamaCare is the devil glasses, and accept that your employer is choosing a different plan on their own, and that Wayne Memorial and Blue Cross are parting ways on their own. There is no Obama fingerprint on any of it.

  • exteacher Dec 5, 6:26 p.m.

    Yeah, BCBS would never distort the truth, would they? You ever look at how much money they got squirrled away? Billions!! How do you think they got that? They should have made huge refunds to all the policy holders they are supposed to be looking after!!! Return the money to the policy holders!!!

    Wake1
    PLEASE produce the evidence that BCBS has 'squirreled away BILLIONS' as you put it. You do not know what you are talking about.
    BCBS is looking out for its customers by refusing to pay the exorbitant prices Wayne wants to charge (all will producing BAD outcomes). Who would go there for treatment??

  • rachel Dec 5, 5:36 p.m.

    junkmail5- your argument sounds good except for one problem-those that are paying through insurance etc-are apt to be sued and have everything they worked for destroyed because they can't pay the co-pays,limits and deductibles for major illnesses-while someone else gets it all for nothing-the bottom line should be either everyone pays or everyone gets it for nothing and it becomes a service rather than a business-I work in health care- I hate seeing the amount of "foolish care" given away in an emergency room while the really sick person next to them is refused or charged for the very same things. Equality goes both ways.

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