ACU will switch to a new insurance provider beginning Jan. 1.
Blue Cross Blue Shield has been the university’s provider in the past, but because Blue Cross’s contract expired with Hendrick Medical Center, ACU made the decision to move to a new provider, Cigna.
Hendrick and Blue Cross began negotiations to renew their contract about one year ago. Over the course of negotiations, Hendrick sent letters to clients telling them an agreement might not be reached between the hospital and Blue Cross.
Blue Cross is known for getting the best deal for their clients, but hadn’t increased its reimbursement rates to Hendrick since 2010. During the negotiations, Hendrick asked that Blue Cross pay the same rates it pays hospitals comparable to Hendrick in size and services.
“The cost to provide care and run our hospital continues to increase every year,” said Tim Lancaster, president and CEO of Hendrick Health System, in a letter to clients on May 21. “Years of below-market payments have created an unsustainable gap that has widened considerably each year.”
This “unsustainable gap” continued to shadow over the negotiations between the two parties.
“They are at complete polar opposites and can’t find any common ground over what the rate should be,” said Wendy Jones, ACU’s chief human resources officer. “Both have really painted the other side as the bad guy, a ‘he said, she said’ kind of thing.”
Blue Cross felt strongly about offering the best rates for clients and Hendrick felt strongly about being paid fairly, but the two parties were unable to reach an agreement before the contract expired on June 30. Hendrick sent a letter to all clients covered by Blue Cross, stating Hendrick Health System would be out of network as of July 1.
Hendrick and Blue Cross continued meetings throughout the summer and into the fall, and as of Oct. 17, the two decided no agreement could be reached for the remainder of 2014 and most likely all of 2015.
“If we were in the Metroplex, it wouldn’t be that big of a deal because there’s four or five hospitals in a 20-mile radius,” Jones said. “But in Abilene, you’ve got Hendrick and Abilene Regional Hospital. All of a sudden, this major section of doctors are no longer in network for several big employers in town.”
ACU, First Financial Bank, the city of Abilene and surrounding towns without hospitals were faced with a decision. They could stay with Blue Cross and no longer have the option of care at Hendrick or move to a new provider and keep both Abilene hospitals in network.
“No matter who we go with, we all expect to pay more next year,” Jones said. “The loser is always the customer.”
ACU made the decision to go with Cigna, and the city of Abilene decided to go with Aenta. Coverage under these new providers will begin in January, Jones said.
Officials at Hendrick said they are no longer answering questions about the dispute.
During the time between providers, some ACU employees were concerned about the situation with Hendrick. Jones said the Human Resources office heard from families expecting babies that were planning to deliver at Hendrick.
Amy Willis, graphic designer at ACU, is pregnant and was expecting to deliver her baby at Hendrick.
“We had my first child at Hendrick, and I was hoping we would have our second one there,” she said. “Once you’ve done it once and know where to go and where everything is, it’s pretty fantastic. But my doctor ended up switching to Abilene Regional because too many of her patients are Blue Cross Blue Shield.”
For Willis and other patients with similar situations, normal doctor visits were changed because lab work could no longer be sent to Hendrick.
“The hard part for me was with Hendrick no longer accepting Blue Cross Blue Shield in June, all the blood work and everything had to be sent somewhere else,” Willis said. “I had to make the switch much sooner.”
Hendrick and Blue Cross tried to work with clients who are in situations were more attentive medical care is required, Jones said.
Terri Aldriedge, Body and Soul director, visits Hendrick every four weeks to have blood work done because she had open-heart surgery when she was 30.
“I had to decide, do I keep the cardiologist I’ve had for 10 years, one who knows my body very well, or get a brand new one, knowing that in January, ACU would do all that they could to get us back to Hendrick,” she said.
Aldriedge’s doctor worked to negotiate a price for her visits during the time not covered by Blue Cross.
“This is a big investment for me to stay with my cardiologist; I’m not going to pay $400 to come in for a visit,” Aldriedge said. “But Hendrick came up really quick and said it’d be $75-$100 a visit, so we’ve been paying extra for me to go.”
Aldriedge said all of her health professionals will now accept Cigna in January so she will be able to remain at Hendrick.
“I think ACU has tried to do as much as they can do,” Aldriedge said. “The bottom line is, the patients lose.”