Blue Cross/Blue Shield AZ insurance no longer accepted at Dignity Health-YRMC
As of Feb. 1, BCBS patients will be out-of-network for most services; agencies negotiating payment reimbursements
As of Tuesday, Jan. 31, Dignity Health-Yavapai Regional Medical Center is no longer accepting patients with Blue Cross/Blue Shield Arizona insurance coverage given a dispute between hospital leaders and the insurance carrier over reimbursement for certain medical care and surgical treatments, the two agencies confirmed on Monday.
In a statement mailed to patients, Blue Cross/Blue Shield officials stated they have been negotiating with Dignity Health-YRMC since September over the amount of increases the hospital wants the insurance agency to pay for “covered services.”
“Since then, we have been working to negotiate a reasonable increase and to keep them in network,” the document reads. “Despite our best efforts, they are choosing to leave on Jan. 31, 2023.
“The excessive double-digit increases that Yavapai Regional Medical Center is demanding will cause you to pay more out-of-pocket for their services. Services such as colonoscopies and minor surgeries at Yavapai Regional Medical Center already average 80% higher than the same service in Phoenix. Providers should absolutely be paid fairly, but it’s not fair that members in rural communities pay more for services just because one provider dominates the market,” the Blue Cross/Blue Shield document said.
Dignity Health-YRMC operates two hospital campuses – one in Prescott and one in Prescott Valley. Both have emergency rooms and in-patient hospital care, with Prescott Valley also home to the BreastCare imaging center and a family birthing center. It is now the sole, full-care hospital facility in western Yavapai County, with a large portion of area residents depending on YRMC for the bulk of their medical and surgical care. Beyond the hospital campuses, YRMC also operates Yavapai Regional Medical Group (YRMG), which includes more than 20 primary and specialty clinics operated by their doctors and medical practitioners.
This comes as quite a blow to many patients in the greater Prescott area employed by the state and other agencies or businesses that prescribe to this brand of insurance coverage, sources said.
Blue Cross/Blue Shield also offers various supplemental and Advantage plans for Medicare-eligible individuals. Blue Cross/Blue Shield leadership informed their customers that they will likely need to find new in-network providers for certain procedures given the unresolved reimbursement dispute between the two entities.
“We would like to keep Yavapai Regional Medical Center in our network,” a Monday, Jan. 30 Blue Cross/Blue Shield news release stated. “There is an offer on the table that is already higher than most other providers in the state and we are hopeful that they will accept this offer.”
A retired state employee, 74-year-old Kathryn Medoff said as much as she is disappointed that the two entities couldn’t reach a patient-oriented compromise, Medoff said she questions why Blue Cross/Blue Shield during open enrollment didn’t mention to its customers that there was an issue because she could have opted to sign with United Health for a plan at the same cost.
“I can’t travel for health care; it needs to be local,” said Medoff, who has been a Blue Cross/Blue Shield customer for five or six years and sees this as customer betrayal.
As much as this will impact her life, Medoff said she empathizes with those who now work in state departments who will have to take personal days to manage their health care needs outside the area. She further noted to switch doctors can take several months.
“This is not advantageous for anybody,” Medoff said.
Dignity Health-YRMC leaders suggest that both the hospital leadership and its medical group have tried to negotiate a compromise but have been unable to do so at this time.
This issue with Blue Cross/Blue Shield does not impact patients covered by other companies’ forms of medical insurance.
If no agreement is reached by Tuesday, Jan. 31, then on Wednesday, Feb. 1, Blue Cross/Blue Shield AZ covered patients can access their primary care medical teams as out-of-network rather than in-network providers, according to a Dignity Health-YRMC news release on Monday, Jan. 30.
Out-of-network costs are higher.
“At a time when nonprofit hospitals across the country are struggling financially, we need responsible agreements that allow our nurses and doctors to continue providing the essential health care our community needs,” the hospital news release states.
“YRMG and YRMC continue to work with BCBSAZ to reach new agreements as quickly as possible to protect patients’ access to physician and hospital services on an in-network basis,” the release said. “Toward that end, YRMG and YRMC have offered BCBSAZ an agreement with rate increases below cost inflation for hospital services as measured by the Consumer Price Index.
“Contrary to communications BCBSAZ sent to employers and members, throughout this negotiation, the rate increases proposed by YRMG and YRMC combined have been in the single digits.”
Officials with both Blue Cross/Blue Shield and Dignity Health-YRMC said despite the contract conflict patients with this coverage will still be provided emergency care at the hospital’s two campuses at in-network prices. Patients in active treatment may also still be eligible for in-network care. Patients are advised to be in contact with the insurance carrier’s care support personnel.
With access to what it says is the “largest network of providers in Arizona,” Blue Cross/Blue Shield leaders informed patients their care support teams will work with individuals to find new in-network providers but expect that some will not be as close to their homes. The insurance provider did indicate that some patient coverage will provide financial help with medically-related travel costs.
“We appreciate our responsibility as the region’s major provider of high-quality health care services,” the hospital news release said. “Our primary focus is ensuring access to needed care, and we recognize the inconvenience this situation creates.”
Various social media sites have proved a venue for many Blue Cross/Blue Shield patients to express their frustration and anger over this latest change in their medical care. Some said they feared the alliance with Dignity Health might lead to just such actions given it has a monopoly on medical care in the greater Prescott area. Several said the alliance was supposed to provide more and better care close to where patients live, rather than less care farther away. A few were disappointed Blue Cross/Blue Shield is also unwilling to compromise from a position that will impact the care its customers can afford.
“YRMC and YRMG will continue to do everything we are able to renew these agreements at terms that provide resources needed to continue providing the care our community deserves in advance of a termination,” the hospital release concluded.
Patients with concerns are advised to call 1-702-616-5786.
Reach Nanci Hutson at email@example.com or call 928-445-3333, ext. 2041.
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