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Both sides are hopeful they can resolve their contract dispute that has been dragging on for months.
By KRIS HUNDLEY, Times Staff Writer
© St. Petersburg Times, published January 7, 2003
Three months after their contract ended in a stalemate, the Tampa Bay area's largest insurer and its biggest hospital network are back at the negotiating table, trying to work out an agreement.
Since Oct. 1, the seven hospitals of BayCare Health System have been considered "out of network" for about 300,000 BlueCross BlueShield of Florida members.
People enrolled in the Blues' commercial HMO have been unable to use the hospitals for any treatment other than emergency purposes.
Members of the Blues' PPO and traditional plans have been responsible for higher co-pays if they choose the BayCare hospitals, which include St. Joseph's, St. Joseph's Women's and Tampa Children's in Tampa; South Florida Baptist in Plant City; North Bay Hospital in New Port Richey; Morton Plant in Clearwater; and St. Anthony's in St. Petersburg.
People with Medicare supplement coverage through Blue Cross' Advantage 65 plan have not been affected by the contract termination.
Though neither the hospitals nor the insurer concede any negative impact from the impasse, they say they are hopeful it will be resolved soon.
Mark Wright, a spokesman for the Jacksonville insurer, said BlueCross has not noticed members migrating to more expensive PPO coverage from HMOs to give them access to BayCare hospitals. He also was unable to say if BlueCross members had switched to other insurers as a result of the disagreement.
"Membership numbers won't be established until mid-February and even then they'll be proprietary," Wright said. "But we're still confident an agreement with BayCare will happen."
Last year, BayCare's contract with BlueCross contributed $80-million of revenue to the hospital system. About 8,000 Blues members received treatment at BayCare as inpatients; another 41,000 were treated on an outpatient basis.
One stumbling block in the negotiations has been BayCare's pressure for higher reimbursement for outpatient services. The hospital network has also pushed for fairer and faster repayment of claims.
Amy Lovett, BayCare's spokeswoman, said the hospitals did not have an estimate of revenues that have been lost as a result of the contract termination.
"Right before the holidays, elective surgery surges, then during the holidays, it declines," Lovett said, citing one indicator of patient counts. "It's very difficult to give any measurement. But I know we've made progress in our talks with BlueCross."
Tampa Bay area doctors seem to be betting that the two parties will work things out. Jane Wittersheim, administrator for an eight-doctor group that is part of Tampa Bay Women's Center, said her obstetricians and gynecologists, who practice solely at St. Joseph's Women, have not tried to get staff privileges at other hospitals. This is despite the fact that about 18 percent of their patients are insured by Blue Cross.
"We're hoping this contract dispute will be resolved in very short order," she said. "Because we've been able to continue to see obstetrics patients (who were pregnant prior to Oct. 1), we haven't felt the full impact of this yet."
While doctors wait, patients like Diane McMillen of Tampa worry. A BlueCross HMO member, she knows that if she needed surgery, her gynecologist, who practices only at St. Joseph's, would have to refer her to another doctor. And her 9-year-old daughter, who has had diagnostic testing at Tampa Children's in the past, would have to switch doctors and hospitals if a need for care arose.
"I think both BlueCross and BayCare have a lot to lose in terms of reputation," McMillen said. "They both talk about patient care, but that doesn't come out in their actions. This situation says that, for both sides, it's purely a money decision. What's a regular person to do?"
-- Kris Hundley can be reached at hundley@sptimes.com or (727)892-2996.