Insurance Dispute Could Cost Patients More - KCBD NewsChannel 11 Lubbock

7/17/07

Insurance Dispute Could Cost Patients More

With the impending deadline, Covenant Medical Group (CMG) patients are already receiving letters in the mail asking them to stick with their doctors no matter the conclusion reached between the group and Blue Cross and Blue Shield (BCBS).

NewsChannel 11 has learned that CMG and BCBS will meet for the first time face to face to discuss the issue. As we've been telling you, doctors within CMG have been at odds with the insurance group over reimbursement fees. The two must come to an agreement by September 18th or thousands in this area may have to search for another doctor or risk paying higher fees with their own.

And that's exactly what CMG doctors are asking their patients to do. The letter explains the issue, but in addition CMG doctors are asking for loyalty.

The letter states, "I genuinely hope you decide to stay with me to maintain our long standing relationship, even though there may be slightly more out-of-pocket expenses..."

So, how much more "out-of-pocket" expenses could you be paying? For example, if you're covered with the PPO plan for the typical "in-network" doctor visit, let's say for a cold or the flu, BCBS currently pays 100% of the doctor visit after a $30 co-pay.

Here's the difference. For an "out-of-network" doctor visit, same cold or the flu symptoms, the patient would have to pay up to the first $500 of the visit and then BCBS would pay 70% of all expenses after that. That $500 is a yearly deductible that must be met for each individual.

So, as you can see, going out of network would be quite costly. Again, September 18th is the deadline for the two groups to work this out, but we could see some new developments Wednesday when both meet face to face for the first time. We'll have the latest on that as soon as it becomes available.

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