Tagged: Blue Cross Blue Shield

An Ottawa County Circuit Court judge is ordering Blue Cross Blue Shield to pay the City of Holland $1.6 million. Holland is one of dozens of communities that sued Blue Cross over variable fees charged on insurance claims filed by employees.  The city claims the insurer didn’t tell them about the fees for 17 years.

Blue Cross Blue Shield spokesperson Helen Stojic says the fees were not hidden.“As the lawsuit proceeds to the appellate courts we’re confident that the legal process will result in a finding that our access fee were known to our customers,” Stojic said.

Stojic says the City of Holland got access to millions of dollars in discounts by paying the fees. “It helped save money – hold down costs for that community,” she said.

Blue Cross-Blue Shield of Michigan has reached a five-year deal with Beaumont Health System that will increase reimbursements to the hospital. It also includes a new performance-based payment model.

The health system had threatened to stop accepting patients covered by the Blues’ HMO, Blue Care Network,  starting next Thursday. 

"It was very unfortunate but the good news is that we’ve rescinded that now, and BCN members will not have gone one day without their services being covered at Beaumont and we think that’s a very positive outcome,"  said Beaumont CFO Nick Vitale.

Officials on both sides say the deal will better coordinate care by establishing programs that avoid unnecessary tests "to make sure that the primary care physicians are speaking to the specialists who are speaking to the hospitals to make sure that if there’s a test performed that it’s only performed once," said BCBSM vice president Sue Barkell.

The five-year contract will boost reimbursements to the hospital. But the two sides would not disclose what the rate increase will be.

LANSING, Mich. (AP) - Michigan Attorney General Bill Schuette says his office is reviewing Blue Cross Blue Shield of Michigan's plans for a joint venture involving a Medicaid coverage company.

The Detroit-based Blue Cross and Philadelphia-based Independence Blue Cross are purchasing AmeriHealth Mercy, which has Medicaid managed-care contracts in states including Pennsylvania, Indiana, and South Carolina.

Schuette said Friday he wants the Michigan-based Blue Cross to provide his office with documentation related to the transaction.

Blue Cross officials said they welcome the inquiry and will work with him to clarify questions about the transaction.

The joint venture could provide an opportunity for Blues insurers nationwide to expand into Medicaid coverage just as states are seeking ways to save money in the program and the ranks of Medicaid enrollees is poised to grow.

Blue Cross/Blue Shield of Michigan is expanding its involvement in Medicaid coverage.  Blue Cross/Blue Shield of Michigan joined a Pennsylvania Blue Cross to buy up a Medicaid health care plan based in Philadelphia.  Amerihealth Mercy serves 4 million Medicaid patients in 11 states.    

Holland is the latest city in Michigan planning to file a lawsuit against Blue Cross Blue Shield over variable fees. The fee is a 13.5% administrative access fee Blue Cross charged the city on any insurance claims filed by employees.  The city claims the insurer didn’t tell them about the fees for 17 years.

Holland Mayor Kurt Dykstra says,

“It’s my understanding that actually one of our finance people at one point did ask a question of Blue Cross Blue Shield specifically related to the fees that they were charging and was told by BCBS that - no there were no additional fees, no additional charges being passed along. Now it turns out that may not in fact have been the case.”