Franciscans, Blue Cross Come To Agreement – Maybe

After months of often nasty and certainly public back-and-forth negotiations between Louisiana’s largest health insurer and one of its most prominent hospital groups, the two parties have come to a meeting of the minds – just 11 days prior to the end of their current service agreement.

Or at least, Blue Cross/Blue Shield of Louisiana says they have. The insurer, which has a market share above 60 percent within the state, issued a statement largely declaring victory in the negotiations – after spending the last couple of weeks running ads hammering the Franciscan Missionaries of Our Lady for what Blue Cross says is a cost structure whereby only 55 cents of every dollar spent in their hospitals actually goes to patients. Blue Cross put out a happy press release declaring the agreement today:

Blue Cross and Blue Shield of Louisiana is pleased to announce that the Franciscan Missionaries of Our Lady Health System, or FMOL, has agreed to hold the line on costs by accepting the insurance company’s final offer. This offer, made Jan. 8, allows for a minimal inflationary increase.

This means that Blue Cross customers can continue to count FMOL hospitals and affiliated providers as part of their Blue Cross and HMO Louisiana networks, even after the previous contract expiration date of Feb. 1, 2010.

FMOL hospitals are well-respected in their communities, and Blue Cross officials expressed satisfaction that they will continue to be part of the company’s strong statewide networks. “We have a long-standing relationship with FMOL, and our goal was always to keep them in our networks,” said Mike Reitz, Blue Cross President and CEO.

Reitz added, “I am pleased we were able to settle our differences and come together to work in the best interests of our customers. As we’ve said all along, healthcare reform is both a national and local concern, and all stakeholders – customers, healthcare providers and insurance companies – must work together to keep high-quality healthcare accessible for the people of Louisiana.”

Hospitals in the FMOL System include:

* Our Lady of the Lake Regional Medical Center, Baton Rouge
* Tau Center of Baton Rouge
* St. Elizabeth Hospital, Gonzales
* Our Lady of Lourdes Regional Medical Center, Lafayette
* Heart Hospital of Lafayette
* St. Francis, Monroe (both campuses)
* Assumption Community Hospital, Napoleonville

The continuation of FMOL’s contract with Blue Cross means that physicians and providers affiliated with or employed by the system will also remain in the insurer’s networks.

Any customer who needs an updated network listing, to see if a doctor participates in his or her network or to see if a doctor has admitting privileges at a specific hospital may use the searchable directory on the Blue Cross website at or call the physician’s office. Customers may also call the Customer Service telephone number listed on their ID cards.

“We understand this has been a challenging time for our customers and for all parties, but we have been absolutely committed to you and to heeding your request to hold the line on healthcare costs,” Reitz said. “As a non-profit mutual company owned by our policyholders, we take our responsibility to manage your money wisely. Blue Cross will continue to work as an advocate for you going forward.”

But FMOL, which operates eight hospital campuses in Baton Rouge, Gonzales, Lafayette, Napoleonville and Monroe, issued the following rather noncommittal, not-so-fast statement:

Franciscan Missionaries of Our Lady Health System has received a proposal from Blue Cross Blue Shield and it contains provisions that must be validated for legal and regulatory compliance. Both the FMOLHS and BCBS teams have been meeting since early this morning (Thursday, January 21, 2010). The Blue Cross team has been cooperative and doing their best to understand and explain their proposal to us. There has been good progress but we’re not done.

Like any responsible business, FMOLHS cannot sign a contract that has provisions in it which cannot be validated as legal. For that matter, neither should Blue Cross. We need to be confident the provisions are within the law and can be reasonably provided.

While we work toward a contract agreement, we have prepared to be an out of network provider for Blue Cross in the event an agreement is not reached. Patients must have important information so they don’t avoid needed healthcare. We have asked Blue Cross to do the right things for patients in terms of coverage especially for care issues beyond the patient’s control. Continuity of Care and coverage for unique services are of particular concern. People suffering from serious illnesses should not be forced to consider the incremental costs they will incur if the only access to the care they need is out of network.

Perhaps things will clarify tomorrow. So far, the two parties still appear to be in a bit of disharmony as to their communications.



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