Covenant Medical Group and Blue Cross Blue Shield - Will Their Relationship Last? - KCBD NewsChannel 11 Lubbock

9/14/07

Covenant Medical Group and Blue Cross Blue Shield - Will Their Relationship Last?

Come Tuesday, 12,000 Lubbockite's could be changing doctors. That's the deadline for a resolution between Covenant Medical Group (CMG) and Blue Cross Blue Shield (BCBS). It all started when doctors associated with the CMG asked for higher reimbursements from BCBS. With a deadline looming, many patients are already searching for other options.

"We do have patients that do come because of the Blue Cross situation," Dana Rains said.

Rains is the COO for Grace Clinic on The Marsha Sharp Freeway.

"We see about 17,000 calls on average. We've seen an increase of about 400 calls a week over the last couple of weeks," Rains said.

Rains believes that many of those calls are from current CMG patients seeking new doctors because of the ongoing dispute.

"There are some people who are very aware of making a change when it relates to the change with BCBS, and there are some that don't think about their health until they're sick, quite frankly. We're trying to prepare for both," Rains added.

But how close is the medical group to breaking from the insurance company? Dr. Scott Robins is spearheading Covenant medical group's efforts in this case.

"My expectation is that the contract will lapse on Tuesday," Robins said.

CMG is an association of about 200 doctors so not simply doctors within the Covenant Health System. The doctors in the group say they make less than other doctors in this market. BCBS says that's not the case.

"We've had ongoing discussions with them about issues of transition of care for patients but there has been zero communication with them about our only issue which is reimbursement," Robins said.

And because of that, if an agreement is not met, patients will be considered "out of network", most likely paying higher prices if they wish to stick with their current CMG doctor. Unless, of course they switch doctors...

"We do have patients coming in to request records. In a new facility, that's not unusual but we do see that growth," Rains said.

Several patients did receive letters from their doctors asking them to stay despite higher prices. We placed a call to BCBS Friday for their side, and they declined comment. They did say however they're still hopefully and will comment next week when they better know how all of this will turn out. We want to stress again, this affects patients who go to a CMG doctor not the hospital itself.

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