Friday, January 09, 2009

Blue Cross vs. Tufts Medical Center: Patients to Pay the Costs

Hat tip to Alicia over at the Awesome Cancer Survivor blog

I hadn't heard about what's going on in Massachusetts, so I'm guessing that a lot of other folks might also be unaware. Tufts Medical Center is a teaching hospital located in Boston. Because of its state-of-the-art equipment and clinical trials, many people with cancer, heart disease and other chronic conditions receive treatment at the Tufts facility.

Blue Cross of Boston, the biggest health insurer in the state, has been engaging in negotiations with Tufts Medical Center over the reimbursement rates that the hospital receives for treating patients. Right now, Tuft and its doctors receive between 20 to 40 percent less than other teaching hospitals in the area and they are seeking a 9% increase. Blue Cross of Boston is refusing to give Tufts the increase they are asking for. This means that Tufts patients who have insurance coverage through Blue Cross of Boston will have to find new doctors, because the hospital will no longer accept their insurance after February 3rd.

This is a potentially life-threatening situation. My doctors had never encountered a patient with chondrosarcoma before. The fact that my oncologists, my rheumatologist, and my general practitioner are all down the hall from each other allows them to manage my care quickly. There have been several times when I had to be ferried down the hall for my other doctors to examine me so that they could decide which condition might be causing the symptoms I was experiencing.

If I had to start over and find a new hospital, I'd have to find--not just one oncologist who was trained to deal with sarcomas--I'd also have to find other doctors who are comfortable treating a patient with so many co-morbid diseases. Without my doctors working together, my conditions simply can't be managed. I know this for a fact. It was a situation that I faced after Hurricane Katrina.

This fight between Tufts and Blue Cross is leaving seriously-ill patients in a dangerous position. Even though Blue Cross is saying that seriously ill patients will have an additional three months after February to receive treatment at Tufts and have those treatments covered by their insurance, it doesn't really change the fact that many people simply can't change hospitals without endangering their life and potentially worsening their condition(s).

I blame Blue Cross of Boston. Tufts isn't asking to be paid at the same reimbursement rates as Blue Cross' highest paid health providers. The 9% increase would simply make them more competitive. If doctors at Tufts are making less money than they would if they went to some place else, then what incentives are there for them to stay? If the hospital can't attract good doctors, then they can't provide the kind of care that their patients need. If patients don't get the best care they could have received, more of them will die. If I hadn't been for the best care that the country had to offer, I'd certainly be dead. For many patients, Tufts is the best facility for them to use.

I don't know what's going to happen but I do know what should happen. Blue Cross should agree to the increase instead of putting patients' lives at risk. Now, I guess we'll have to see what decision they'll make. If anyone has any ideas about how to put pressure on Blue Cross of Boston, please let me know. This deserves attention.


Anonymous said...

Hey there! Thanks for the great post. I think you really summed up the situation very nicely.

To help out, please RT the link to Tufts site that outlines what patients can do:

I'll email you some other ideas on how to help. This is a great start!

Stales said...

Thank you for this post. It provides a great outline of the issue. You can point your readers to:
for more information on what to do. You are right, we need to make sure that Tufts and BCBS come to an agreement! Thanks for writing this!

dmarks said...

BCBS recently ran a misleading ad campaign in Michigan, trying to get the legislature to ban competition. I always do a double-take when they are called a "nonprofit", and the bosses there rake in millions. I used to think of nonprofits as tending to be charities, and have long since been corrected.

Mary McManus said...

I am so impressed by your courage and passion to reach beyond yourself and bring awareness to what is happening at Tufts. Thank you for sharing the beauty of your Spirit, and your courage. What a blessing to know you, @stales and so many who are such a source of inspiration.

Stales said...

Here's some more information that your readers might want to review:

1) Great post on the Health Care Marketing Blog:

2) A nice review of the issue on this blog as well:


Stales said...

You can now join a facebook group to support the cause:

Please join "Tufts Medical Center Campaign for a Fair Contract

libhom said...

This is yet another example of why we need single payer healthcare.