Hospital and Blue Cross continue negotiating reimbursement rates | SierraSun.com

Hospital and Blue Cross continue negotiating reimbursement rates

Sierra Countis
Sierra Sun

Tahoe Forest Hospital is working to finalize contract negotiations with Blue Cross regarding reimbursement, said Paige Nebeker, the hospital’s director of marketing and media relations.

Tahoe Forest was notified by Blue Cross in late January of the insurance company’s intentions to re-negotiate the hospital’s contract regarding reimbursement rates.

Blue Cross “uncovered charge increases by Tahoe Forest Hospital that were significantly higher than the inflation rate set in the hospital contract,” stated Tammy Taylor, Blue Cross corporate communications spokesperson, in an e-mail to the Sierra Sun.

The charge increases were detected through Blue Cross’ routine monitoring of hospital trends, charges and contractual performance, Taylor said. Blue Cross is working with Tahoe Forest to renegotiate the contract in order to find a “mutually acceptable solution,” Taylor said in the statement.

Nebeker said there was “some discrepancy” in the prior contract agreement over how much money Blue Cross was to reimburse to Tahoe Forest and “that was the only issue” at hand.

The negotiated amount of the reimbursement rates in the contract is confidential information, she said.

Meanwhile, Tahoe Forest accepts, and will continue to accept, those insured by Blue Cross, Nebeker said.

“That [coverage] was never in question,” she said.

A 2005 study conducted by Milliman Inc. and Blue Shield of California found that low reimbursement rates paid by Medicare and Medi-Cal to hospitals and physicians leads to these providers then charging private insurers higher rates for services ” to make up for the low reimbursement amounts from Medicare. This has resulted in cost-shifting onto private insurers amounting to 9.5 percent of premiums. With premiums for employer-sponsored family coverage in California averaging just over $10,000 per year, this translates to approximately $950 per policy that private insurers are now asked to pick up, according to blueshieldca.com.