Providers face another cap

Saturday, February 28, 2009

NASHVILLE, Tenn.--Providers here are feeling crunched by Blue Cross Blue Shield of Tennessee’s (BCBST) plan to cap DME reimbursement at $2,500.

As commercial policy renewals commence over the next year, BCBST will apply the cap to plans with 150 members or fewer, providers say.

“We’ll be quoting prices directly to the patient to privately pay for equipment more than $2,500,” said Jeff Carr, president of Knoxville-based Carr Rehab. “It’s going to hurt business, but it’s going to hurt the end user more.”

Other insurance companies have put caps on DME, providers acknowledge, but BCBST is on the low end of the scale.

“I cannot believe that Blue Cross is going to deny an enrollee a $5,000 chair for a very involved child,” said Joel Holland, president of Nashville-based Holland Medical.

Providers are hopeful that BCBST will carve out DME from the cap. It has already done so for O&P  and respiratory services.

Darren Jernigan, director of government affairs for Lebanon, Tenn.-based Permobil, says legislation that would prevent private insurance companies from capping DME probably wouldn’t pass muster in the state’s Republican-controlled House and Senate.

“This is starting to happen nationwide,” he said. “Private insurance used to be a place where you could get your MSRP, but you’re not going to get a chair for $2,500 anywhere.”

A bill that would have prevented DME caps passed the California legislature last year, but it was vetoed by Gov. Arnold Schwarzenegger, who said it would “only serve to increase the overall cost of health care.”