Carney Promises No Change in Service, Despite New Fees

Patients with Blue Cross health plans who go to the Caritas Carney Emergency Room for treatment will not experience any changes in their care despite a payment dispute between the ER doctors and the insurance company, the Dorchester hospital promised. "This will not impact patient care, treatment or coverage," said Patrice McCune a spokeswoman for the Caritas hospital system.

According to McCune, and published reports, Blue Cross's new payment process went into effect on January 1. At that time, HMO Blue customers and those with other Blue Cross plans would have to pay the ER doctors on their own and be reimbursed by the insurance carrier.

Under the payment plan, the carrier would send the check for the doctor payments directly to the customer, instead of the normal procedure of sending it directly to the Caritas Medical Group, which covers the ER doctors.

All parties have noted that the billing change will not affect ER services and procedures in any way. Those will still be paid by the carrier in a normal fashion.

"We will still bill Blue Cross on behalf of the patient," McCune said. "Instead of Blue Cross sending the payment to us, it will be sent to the patient."

At that point it will be the patient's responsibility to forward the money to the attending ER physician.

According to McCune, the dispute lies between the Caritas Medical Group and the insurance company. She would not go into specifics but did say the dispute was around the amount of reimbursement the physician's groups are receiving from the insurance plan.

She noted that patients using the emergency room at any of the six Caritas Christi facilities will receive a notice in their bills explaining the new procedure. Caritas is an umbrella group for Caritas Carney in Lower Mills; Caritas St. Elizabeth Medical Center, Brighton; Caritas Good Samaritan Medical Center, Brockton; St. Anne's Hospital, Fall River; Caritas Holy Family, Methuen; and Caritas Norwood Hospital, Norwood.

"We are trying not to impact the patient in any way," McCune said. "Patients will still be seen."

The same message is coming from Blue Cross to their members.

"Our members are encouraged to seek treatment at any hospital in the world," said Deb Devaux, senior vice president of Health Care Contributions Management. "The only thin changing is the way we pay the doctors."

Devaux said that the patients at Caritas Health Care systems would receive the full amount of money being billed by the doctors, minus the co-pay, as set out in their health plan. The only difference is the payment will go to the patient who must then forward it to the doctors.

"In order to maximize the efficiency of payments, some doctors are billing us directly," Devaux said.

According to Devaux, plans for the payment schedule started about two years ago in an attempt by the insurer to bring medical costs into line. During that time the company worked with physicians to develop a fee schedule that would be reasonable for all concerned.

"We're concerned about paying reasonable costs and maintaining quality services for our members," Devaux said.

She claimed that all of the area hospitals are in agreement on the fee schedule and about 90 percent of the emergency room doctors are participating.

"We are in direct negotiations with [the Caritas Medical Group]," Devaux said. "We have a long relationship with them and we are in discussions."

Devaux noted that due to the sensitivity of the negotiations she could not go into detail on their status.

Boston Public Health Commission officials did not return phone calls seeking comment for this article.


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