Massachusetts: Warning: Information you provide may be used against you

Thursday, August 26, 2010

BOSTON - Providers here who count Blue Cross Blue Shield (BCBS) of Massachusetts among their payers may find themselves shut out if the insurer decides to limit its provider network.

On July 1, BCBS sent out a confidential request for information (RFI) to providers. The 16-page document states: The information you provide may also be used to develop a limited or select network of affordable high quality DME providers focused on clinical outcomes, efficiencies and cost effective care.

"We did ask for a meeting but they would not meet with us," said Karyn Estrella, executive director of the New England Medical Equipment Dealers Association. "I am hoping after they get all of their feedback from the RFI that they might agree to a meeting before they go any further with this."

The RFI's 78 questions include "What do you consider your company's key strengths and weaknesses?" Responses are due Sept. 3.

Providers in Massachusetts have good reason to be concerned. Last November, BCBS of Florida used a closed bid process to shrink its provider network to about 15 providers for the entire state.

"The (BCBS provider network) is less than 10% of what it was," said Sean Schwinghammer, executive director of the Florida Alliance of Home Care Services. "Most of the major insurers have consolidated their networks. As a result, we've been hearing reports of patients having to go into hospitals or nursing homes."

With Medicare's competitive bidding program around the corner, losing such a large private payer will hurt.

"A lot of people were hoping if they didn't get bids they could rely on their private insurance business," said Estrella. "If these private insurers start to cherry pick their providers, it's going to wreak havoc on the industry."