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Blue Cross Decision Further Erodes Patient Choice

Written By northidahodpc

Blue Cross Decision Further Erodes Patient Choice

November 7, 2016

I read with dismay the October 23rd Press article entitled “Health exchange patients at Blue Cross crossroads”.  When will the assault on our freedom to choose the most appropriate healthcare provider for ourselves and our families end?  Starting in 2017, current Blue Cross patients who obtain insurance through the healthcare exchange or from the Blue Cross of Idaho website can only choose a primary care provider within the newly formed Kootenai Care Network.  If a specialty consult is needed, this provider too must be a part of the Network.  Patients who seek care outside this list of providers will be responsible for paying out-of-network rates, up to $75,000/year for an individual and up to $100,000/year for a family!  Those who don’t make a change in their current coverage by December 15th will be forced into this restrictive plan.  All this while health care premiums continue to rise at double digit rates.  Monthly insurance premiums are becoming so expensive that many patients cannot even afford to see their doctor.

The article infers that this consolidation will improve the quality of care, as well as save Blue Cross money.  Patt Richesin, Network president, is quoted as saying…”Before, it was difficult for physicians to have conversations (about specific cases), even if they were across the hall from each other.  Now we are reversing that.  The purpose is to be inclusive.”  Peter Sorensen, who works for Blue Cross, concedes that this move “discourages people from wanting to wander around” and seek care from an out-of-network provider, which costs Blue Cross more money but in reality does little to affect their profitability.

As an independent family physician and urgent care provider practicing outside the Ironwood medical corridor, I have no difficulty discussing cases with my specialty colleagues, and I provide excellent, cost-effective care without being a member of the Kootenai Care Network.  Blue Cross already does quite well financially, and this move to restrict provider access is clearly a profit-motivated, political maneuver in conjunction with Kootenai Health.  Open competition between health care providers, hospitals and insurance companies helps keep costs down and improves quality of medical care.  The current arrangement between Blue Cross and Kootenai Care Network is a clear example of a health care monopoly, and will ultimately drive costs up further, while potentially affecting the quality of medical care.

Patients have a right to choose their own health care provider, and not to have their care restricted or interfered with by any insurance company.  The current arrangement between Blue Cross and Kootenai Care Network is clearly an example of this, and patients need to let Blue Cross know that they have had enough of their price gouging and restriction of health care options.  Consumers should realize that there are less expensive, non-insurance alternatives to Blue Cross that are ACA-compliant.  Known as health care sharing ministry (HCSM) programs, these non-profit entities include, among others, Liberty HealthShare, Samaritan Ministries, Christian Healthcare Ministries and Medi-Share.  Other traditional insurance companies that operate in Idaho include Regence Blue Shield, Pacific Source and Bridgespan.  Ideally, insurance products should be able to be sold across state lines, as this would drive down costs dramatically due to increased competition.  Direct care medical practices such as ours also help keep healthcare costs down while improving access, and are best paired with a HCSM or a high deductible, catastrophic insurance plan.

Now is the time to voice your concerns about this monopolization of medical care.  Let Blue Cross, Kootenai Care Network and your legislative representatives know what you think about this further erosion of health care access.  And consider investigating other insurance and non-insurance products well before December 15th, which if obtained may potentially save money while at the same time increase options for medical care.

Richard R. Samuel, MD, ABFP

North Idaho Direct Primary Care

 

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