Grady Health System has turned a business dispute with Blue Cross and Blue Shield of Georgia into a kind of health-insurance holy war, accusing the insurance giant of caring more about profit than people and launching a social media campaign to belabor the Blues.
Blue Cross and Grady, respectively the state’s largest insurer and its biggest hospital, parted company a month ago after nearly a year of contract renewal talks broke off and their agreement expired. Thousands of Blue Cross customers found that Grady Memorial Hospital was suddenly “out of network” (insurance-speak meaning “consumer pays more”).
Grady has since hauled out the hashtags – #Befair2Grady and #ShameonBlueCross – for a Facebook barrage, lined up people in the community to pick up Grady’s banner, fired lengthy press releases into the ether, even published the name, number and email of the Blues’ CEO.
Blue Cross on Friday deflected Grady’s assertion that the insurer is more focused on profit than people.
“It’s a distraction from the real issue,” spokesman Tony Felts wrote in an email. “Grady is demanding a rate increase that is several times the inflation rate. If we agreed to that demand, it would have a negative impact on the cost of health care for consumers.”
Blue Cross customers accounted for about 20,000 patient visits to Grady last year, the hospital said. Only about 11 percent of Grady patients have private insurance, and most of them are covered by Blue Cross.
The massive public hospital’s emergency department is still open to all, and Blue Cross customers have the option of going to nearby Atlanta Medical Center, also a level-one trauma center.
If Grady’s Blue bashing seems a little over the top, the hospital says it has had to resort to making such accusations.
“We’ve delivered these messages in our campaign because Blue Cross didn’t listen to us, and we can only hope they will listen to the community,” said Lindsay Caulfield, senior vice president for public affairs and marketing at Grady Health System. “We really don’t want to spend time and energy on this issue, worrying about whether we’re going to get paid or how much.”
In sum, Grady accuses Blue Cross and Blue Shield of Georgia of paying Grady less than it pays other hospitals for outpatient services. Grady does concede that, when you include inpatient reimbursements, the hospital makes a small profit from its business with Blue Cross.
In one detailed press release, Grady cited a 2012 study showing payment disparities for outpatient procedures. For example, it said Grady is reimbursed $1,294 for outpatient surgery, while other hospitals receive $5,447.
The insurer is unmoved.
“Grady … acknowledges what we’ve been saying all along: that on their total contract with Blue Cross and Blue Shield, they make a profit,” Felts said. “We’ve submitted five contract proposals to Grady. Each one contains a significant reimbursement increase across the board, including for outpatient services, which they say is an area of particular concern. They’ve rejected each of those proposals.”
Concerned Black Clergy, an activist group of ministers who advocate for the poor, has asked Georgia Insurance Commissioner Ralph Hudgens to investigate Blue Cross. “Grady serves the poor and the indigent and often the most vulnerable in our society and should be treated fairly by Blue Cross,” the group said in a press release.
But Hudgens says he has no standing in the issue.
“Georgia law does not grant my office the authority to approve or disapprove negotiated reimbursement rates between health insurers and hospitals,” he said in a statement.
“I believe that it is in the best interest of Georgia consumers for Grady Hospital and Blue Cross Blue Shield to resume their contractual relationship, and I encourage both sides to work towards that end.”
Both parties say that’s what they want, too.
“They told us three weeks ago they saw no reason to continue contract talks,” Felts said recently. “We hope they’ll reconsider and come back to the negotiating table.”
Caulfield counters, “Our primary interest in this campaign from day one has been to secure a contract with Blue Cross. But Blue Cross has shown little interest in resolving this issue… . We’re hoping that Blue Cross will come to realize this is a mistake, and that we will get this contract issue resolved soon.”
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