Insurance struggle delivers problem for doctors: Obstetricians wonder about their future with River Park
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What is worrisome to two local obstetricians, Dr. Rene Del Valle and Dr. Michael C. Good, is whether River Park will continue to waive out-of-network charges next year as the hospital is doing through the end of this year.
“The problem we’re having is that we’re already losing patients who are pregnant now,” said Dr. Del Valle. “They’re not sure, and the uncertainty scares people. A lot of the patients who live here and in the surrounding areas and would be coming here to have their babies are now calling for referrals to go out of town, like Murfreesboro or Cookeville, because for next year they haven’t advertised if they’re going to waive out-of-network expenses.”
The issue here, according to Del Valle, is one of consistency.
“Some of these patients are patients who have delivered with me before and they want to come here, but they don’t want to come to me and then find out in the middle of their pregnancy that I won’t be able to deliver them.”
River Park CEO Steve Otto said the hospital is working diligently to address these issues and reassure local physicians, and their patients, but there are still no definite plans to waive out-of-network charges next year.
“And our problem is, even if we decide we would like to, we still have to be allowed to do that by BlueCross BlueShield of Tennessee,” Otto said. “And there’s no guarantee of that.”
But Otto said there could be a brighter side as some patients deal with the issue by changing insurance companies.
“Some of these patients that have BlueCross today, may not have BlueCross by the time they deliver,” Otto said.
Dr. Good said River Park’s sole provider status in the area is the big concern for him.
“I think for us, really, the fact that there’s not another hospital to take the obstetrical patient to is probably the biggest impact I’m going to have,” Good said, adding the situation is going to affect a significant number of his patients.
“It goes even deeper,” he said. “When I say BlueCross, I mean that involves all the TennCare folks. You know, the basis of TennCare was to service out and have several companies competitively bid and stretch our tax dollars further, but there’s only one TennCare plan in this area, and it’s Blue Cross,” he said, “and there’s no contract with them either.”
Dr. Good said BlueCross patients make up a significant portion of his practice.
“I know my last couple of months I’ve been running anywhere from 50 to 60 percent,” he said, noting the potential loss of those patients could be disastrous. “That’s a hard pill to swallow, to think that much is just going to walk out of your life, and you can’t make that up anywhere.”
Otto acknowledged River Park does not currently have a contract with TennCare Select, which is administered by BlueCross, but said that could change.
“We are hopeful that we will be able to re-enter the TennCare Select network, hopefully soon,” Otto said, indicating there are talks in that area. “Right now those negotiations are going on.”
Otto said some of the recent changes in TennCare have put River Park in an even more difficult situation.
“As it stands now, with Xantis and Universal both being kicked out of the TennCare program, TennCare Select is the only game in town,” he said.
According to Otto, River Park delivers around 600 babies per year, and of those around 60 percent are TennCare Select.
Dr. Good said the stalemate has left him in a quandary since he has traditionally had a good relationship with both companies.
“You really hate to see this,” Good said. “HCA has been good to me. Blue Cross has been good to me. But something’s got to give in here somewhere. I would love to see them work something out. There are no easy solutions to this. It’s a shame it’s gotten down to this point.”
Otto said River Park is very aware of the issues resulting from the HCA/ BlueCross impasse and is working to alleviate them.