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Friday, January 16, 2015

Blue Shield, Sutter Impasse About More Than Money

KQEDContract breakdowns between insurance companies and health care providers are nothing new and often blow over after public posturing. But the current failure of Blue Shield and Sutter Health to come to terms on a new contract may be harder to resolve. That’s because the main issues appear to be about much more than money.

While the negotiations grind on, more than 250,000 people in individual and family plans are waiting to see what happens. The contract between Blue Shield and Sutter terminated on Dec. 31.
To be sure, money is a factor. Sutter says that Blue Shield is “demanding reductions in what they pay our organization … that would have a devastating impact,” said Bill Gleeson, a spokesman for Sutter. He says Sutter has asked for “less than a 1 percent increase.”

But Blue Shield claims Sutter is pushing the insurer to accept “new and unprecedented contractual provisions,” says Steven Shivinsky, spokesman for Blue Shield.

The most significant new contractual provision is a requirement to arbitrate disputes.

Now, to any average patient, a request to arbitrate disputes probably doesn’t sound like a big deal. I know I’ve signed plenty of documents with various doctors over the years waiving my right to go to court and agreeing to arbitrate areas of disagreement.

But this is different.

Blue Shield’s Shivinsky says that generally arbitration between insurers and providers goes something like this: A provider and insurer disagree on how much reimbursement there should be for, say, an operation. They can’t agree, they go to arbitration. That happens all the time, he says. “It’s appropriate, it’s inexpensive, it’s fast, and it resolves these issues quickly.” continue reading...

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