Blue Cross amendment
Kel Bergmann
Description
Collection
Title:
Blue Cross amendment
Creator:
Kel Bergmann
Date:
1/20/2006
Text:
Yesterday SCOPe Orthotics & Prosthetics, Inc. sent its letter of termination
to Blue Cross of California for our Orthotic and Prosthetic contract
.
For those unaware of the circumstances, Blue Cross sent out an amendment to
its contract with a 15% reduction in its fee schedule. Any Provider
unwilling to accept this reduction has to terminate its contract within 30
days of receipt of the letter.
We analyzed our data and found out that predominately the work was low
margin, labor intensive products such as foot orthoses. The amount of
custom Prosthetics and hard core Orthotics was surprisingly low. 60 % of
the work is HMO and the rest is PPO.
My front desk tells me it is typical to be on hold for up to 60 minutes
while checking benefits with Blue Cross. Blue Cross has among the worst
coverage of all providers when it comes to custom knee braces. We have been
waiting and upsetting patients for a year to get the correct dollar amount
on the spinal orthoses converted from the K codes. Blue Cross has the most
restrictive yearly benefit coverage cap of any provider we work with, to the
point of being discriminatory to the handicapped population. We never know
what we will be paid until the check arrives from Blue Cross because of the
way our bills are bundled, or how our lines items are deleted or if our
billing is just delayed forever.
With those business tactics how could we possibly justify a 15% decrease in
reimbursement?
We have been hit with rising costs across the board. Our plastics follow
the price of gasoline and oil and have gone up drastically. Our carbon
fiber and titanium is used by the Military and with the war have gone up
drastically. We offer our employees health care through Blue Cross. We
always seem to have double digit inflation every year for our premiums.
This year our Blue Cross Insurance went up 19.8%. Isn't that ironic? They
expect me to pay them 19.8% more a year for our coverage and then try and
take 15% extra out of our reimbursement. We are re-opening our plan year
and are dropping Blue Cross as an option.
They have suggested that we become more efficient and buy cheaper goods. We
are so far beyond that stage that it is almost laughable. Unfortunately,
Blue Cross feels they have the power to try and ram this down our throats.
They expect O and P will just suck it up. I'm tired of sucking it up! If
Blue Cross is successful who will be next? I regret having to take this
action as it will impact my company, our employees and most importantly the
people we serve. However given the arrogance of their approach and their
horrible business practices I feel we have no options but to vote with our
feet.
Kel Bergmann, CPO
President
SCOPe Orthotics & Prosthetics, Inc.
to Blue Cross of California for our Orthotic and Prosthetic contract
.
For those unaware of the circumstances, Blue Cross sent out an amendment to
its contract with a 15% reduction in its fee schedule. Any Provider
unwilling to accept this reduction has to terminate its contract within 30
days of receipt of the letter.
We analyzed our data and found out that predominately the work was low
margin, labor intensive products such as foot orthoses. The amount of
custom Prosthetics and hard core Orthotics was surprisingly low. 60 % of
the work is HMO and the rest is PPO.
My front desk tells me it is typical to be on hold for up to 60 minutes
while checking benefits with Blue Cross. Blue Cross has among the worst
coverage of all providers when it comes to custom knee braces. We have been
waiting and upsetting patients for a year to get the correct dollar amount
on the spinal orthoses converted from the K codes. Blue Cross has the most
restrictive yearly benefit coverage cap of any provider we work with, to the
point of being discriminatory to the handicapped population. We never know
what we will be paid until the check arrives from Blue Cross because of the
way our bills are bundled, or how our lines items are deleted or if our
billing is just delayed forever.
With those business tactics how could we possibly justify a 15% decrease in
reimbursement?
We have been hit with rising costs across the board. Our plastics follow
the price of gasoline and oil and have gone up drastically. Our carbon
fiber and titanium is used by the Military and with the war have gone up
drastically. We offer our employees health care through Blue Cross. We
always seem to have double digit inflation every year for our premiums.
This year our Blue Cross Insurance went up 19.8%. Isn't that ironic? They
expect me to pay them 19.8% more a year for our coverage and then try and
take 15% extra out of our reimbursement. We are re-opening our plan year
and are dropping Blue Cross as an option.
They have suggested that we become more efficient and buy cheaper goods. We
are so far beyond that stage that it is almost laughable. Unfortunately,
Blue Cross feels they have the power to try and ram this down our throats.
They expect O and P will just suck it up. I'm tired of sucking it up! If
Blue Cross is successful who will be next? I regret having to take this
action as it will impact my company, our employees and most importantly the
people we serve. However given the arrogance of their approach and their
horrible business practices I feel we have no options but to vote with our
feet.
Kel Bergmann, CPO
President
SCOPe Orthotics & Prosthetics, Inc.
Citation
Kel Bergmann, “Blue Cross amendment,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/225958.
