What happened with Premera Blue Cross?

You may receive a letter from your insurance carrier, Premera Blue Cross, notifying you that their contract with the Center for Excellence in Dermatology terminates on June 16, 2012.  Please be aware you can continue to receive medical services here until that date.

This action was initiated by Premera and was “without cause.”  Click here for a copy of the termination letter we received from Premera.  Based on feedback from our patients, Premera’s consumer representatives have told patients several different explanations for the termination: That the Center for Excellence for Dermatology canceled the contract, that the Center for Excellence in Dermatology was out of compliance with the contract, and that if the Center for Excellence in Dermatology would only sign the contract there would be no problem. These statements are not true.  Premera has not provided the Center for Excellence in Dermatology any written explanation for their decision to terminate our contract despite written inquires.

Why would Premera do this?

Seven months ago the Center for Excellence in Dermatology settled a three-year audit dispute with Premera. We believe the terms were not favorable for Premera. At the time of settlement, the Center for Excellence in Dermatology was concerned there would be a retaliatory action by Premera. It appears to us that Premera has retaliated.

What does this mean to me?

There are several consequences that follow Premera’s action that will affect you as a patient:

• Increased wait times to see specialists in dermatology. Based on the current waiting list at the Center for Excellence in Dermatology and the waiting lists at the two other local dermatology practices, the wait time to see an in-network specialist in dermatology will increase from 2 weeks to 17 weeks for Premera Blue Cross patients.
• Increased out-of-pocket costs for patients who want to continue their care with the provider of their choosing who will now be out-of-network.
• Increased drive time to access services in Spokane that are currently available in the Tri-Cities but not accessible by a preferred provider. Additional unreimbursed costs include gas, food and hotel accommodations for trips to Spokane for treatment or services from in-network providers.
• Lack of access to unique services that are not offered elsewhere in the Tri-Cities including Moh’s surgery for skin cancers, extended patch testing, intravenous infusion therapy for psoriasis and mole mapping for high risk melanoma patients.

The Center for Excellence in Dermatology currently has 17,398 patients listed in its database as having Premera insurance. Many of these patients are on medications that require monitoring, have skin conditions that need regular treatments, or have a history of skin cancers that need follow up. These patients will be left without access to the specialty care they need.  Premera seems willing to put the physical and financial health of these patients at risk to retaliate for the outcome of a business disagreement that did not go their way.

A history of questionable business practices

Premera’s business practices have been challenged in the past. A class action lawsuit, Love et al. v. Blue Cross Blue Shield Association, et al. , was filed in 2003 before U.S. District Judge Federico Moreno in federal court for the Southern District of Florida in Miami. The complaint identified numerous Blue Cross and Blue Shield plans, including Premera Blue Cross of Washington, as defendants in an alleged scheme to defraud doctors in violation of the federal Racketeer Influenced and Corrupt Organizations (RICO) Act. Click here to see a press release from this settlement announcement. You can read more at:

http://www.hmosettlements.com/pages/bluecross.html

What can you do?

You and your employer pay Premera a great deal of money to receive health insurance and those costs go up substantially every year. These increases in premiums occur at the same time that Premera, which is a nonprofit company, builds a $956.6 million cash “reserves” fund. Premera has a moral and ethical obligation to act in the best interests of the lives they are trusted to insure. By putting their business concerns and profits before patient care considerations they are not living up to this fundamental obligation. See the Seattle Times article from 2/8/12:

3 big health insurers stockpile $2.4 billion as rates keep rising

Write or Call your company’s health benefits manager

Let the benefits manager who buys the insurance policy for your company know that you are not happy. Tell them that the increase in out-of-pocket costs and decreased access to care are not acceptable. There are other alternatives to Premera in the market.

Write the Washington State Insurance Commissioner

File a consumer complaint with the Insurance Commissioner for Washington State. You can go online to:

http://www.insurance.wa.gov/consumers/complaints.shtml

or write to:

Washington State Office of the Insurance Commissioner
PO BOX 40256
Olympia, WA 98504-0256

or call: 1-800-562-6900 or (360) 725-7080

or fax: (360) 586-2018

File a complaint with Premera

File a written complaint with Premera and let them know how you feel. Let them know about the issues of: Your loss of access to specialty care, the increase in your out-of-pocket costs, the loss of continuity in your patient care and your loss of access to specialty services like Moh’s surgery in the Tri-Cities. Be sure to include your name, mailing address, Premera ID number and date of birth on the correspondence. (And, if they send you a reply, please send us a copy.) Their address is:

Premera Blue Cross
Complaint Department
PO BOX 91056
Seattle, WA 98111-9159

Just say no

Your access to health care is in jeopardy. Large insurance companies will continue to make policy decisions that put patients at risk unless you stand up and say, “No.” Make sure your voice is heard.

We care about your health

I speak for all the staff and employees at the Center for Excellence in Dermatology when I say we want to be there for you when you need us as we continue our 22 years of service in the Tri-Cities. We appreciate the trust and confidence that you have shown by letting us participate in your medical care, and look forward to providing you with excellence in dermatology for many years to come.

If you have questions, comments or want to talk further please call Sara Reyna here at the Center for Excellence in Dermatology, or visit this page on our website for updates and news about the termination issue.

Sincerely,

Robert B. Hopp, MD

P.S. Here are a couple of other ideas to make your voice heard on this issue:

• Complain about it on your Facebook page or our Facebook page. Tweet about it on Twitter, and make sure we see your Twitter message by including @HoppDermatology in your message. Complain on any other blog or social media you have access too. The more people you tell the more likely it’ll have an impact.
• Print out the information in the letter we’re sending our patients about this issue and pass it along.
• Leave a comment below to let us and everyone who visits our website know how you feel.