Covenant Medical Group announced last week that Blue Cross Blue Shield of Texas health insurance no longer will be accepted for visits to 187 physicians in West Texas.
The change affects physicians who are members of the Covenant Medical Group, Levelland Rural Health Clinics or Plainview Rural Health Clinic, according to the Covenant Medical Group Web site, www.covmedgroup.org. The change does not affect any individuals's ability to access care at the Covenant Health System hospitals or facilities.
"The dispute was about money - the rate of reimbursement for physicians," said Margaret Jarvis, spokeswoman for Blue Cross Blue Shield of Texas. "Our position was that we were not able to give the double-digit increase that Covenant requested."
Jarvis said she could not divulge the exact amount of the requested increase. Kristen Kothmann, vice president and chief operating officer of Covenant Medical Group, agreed rate information is confidential in all contract negotiations.
"The way our physician contract is designed, Blue Cross comes in and hands us the rates they will pay," Kothmann said. "If we don't agree with the rates, we have to notify them that we want to discuss it. We notified them, and they told us they didn't want to talk about rates."
According to the Web site, for the past several months, the Covenant Medical Group, the Levelland clinics and the Plainview clinics have attempted to negotiate a new contract with Blue Cross Blue Shield that would set new rates comparable to what other insurance companies pay.
"Our standard pricing policy involves equity - treating all physician groups equally," Jarvis said. "We try to be consistent based on geographic areas. If we had changed for CMG, we would have to change for all physicians, and that would change our premiums by about $10,000. Part of our job in negotiations is to hold the costs down for members."
Kothmann said the rate Blue Cross Blue Shield was willing to pay was not acceptable by Covenant's standards.
"Our preference would be to stay connected with Blue Cross," she said. "But they are refusing to talk to us about rates. It makes it difficult to come to an agreement when the other party won't come to the table."
According to the Web site, Blue Cross Blue Shield was unwilling to negotiate, so Covenant Medical Group terminated its four agreements with the insurance provider. Because of this change, Blue Cross Blue Shield may ask its members to switch physicians or pay more out-of-pocket expenses to continue receiving care from Covenant physicians.
"From what we're finding out, a lot of patients don't appreciate their insurance provider getting between them and their physician," Kothmann said. "Some have made a change in their insurance. Some have decided to stay with our physicians."
Kothmann said the process has been difficult for the physicians because their costs are increasing, but Blue Cross has decreased the physician reimbursement by 24 percent during the past three years.
"If you took a cut in pay for three years, you'd feel an impact," she said. "The expectation is to provide the same level of care with less money. It can't be done."
Lubbock County has approximately 40,500 Blue Cross Blue Shield members, Jarvis said. It could not be determined how many of those members receive health services from the Covenant a Group.
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