Blue Cross Blue Shield: Providers see red

Tuesday, September 15, 2009

JACKSONVILLE, Fla. – Providers across Florida received "Dear John" letters from Blue Cross Blue Shield (BCBS) recently, informing them their services would no longer be needed as of Nov. 1.

"We are projecting it will be close to 300 (who lose their contracts)," said Sean Schwinghammer, executive director of the Florida Alliance of Home Care Services (FACHS). "It's substantial."

It appears BCBS, one of the state's largest insurers, used a closed bid process to whittle down its network of providers to only 12 for the entire state. It invited only about 30 larger providers to bid—most providers didn’t even know there was a bid, Schwinghammer said. The bid covered all DME, except complex rehab.

The change is bad news for both providers and beneficiaries, said Joan Cross, executive director of the Florida Association of Medical Equipment Services (FAMES).

"If you add this to what Medicare is doing with the oxygen cap and competitive bidding, how are these people going to stay in business," she said. "I'd like to speak with some of the bigger groups of (people insured under BCBS) and ask them: 'Do you want to have this little choice?'"

The letters invited providers to call with questions or concerns, but so far, providers aren't getting any answers, said Schwinghammer.

"We have members who have been BCBS providers for years that have called and no one has responded to them," he said.

FAHCS and The VGM Group have proposed to BCBS grouping all terminated providers under VGM's managed care division, Homelink. The group would match the winning bid prices and bill through one number.

"This would save BCBS the administrative money and meet the financial gain they want," said Schwinghammer. "We respect their right to make business decisions. We are just trying to offer an alternative."