Delta Medix has tried to negotiate a fair contract with Blue Cross of Northeastern Pennsylvania for its First Priority Life products FPLIC Traditional, FPLIC PPO, FPH (First Priority Health).
Our request was significantly less than what other insurance companies are currently paying us. In fact, our request for increased fees is significantly less than our current charges. We were willing to take the reduced rate in fees so we could continue to care for you our patients.
However, Blue Cross refused to put forth nothing more than a token increase in our fee schedule after seven years with no increase. This no doubt makes it more difficult to provide the quality care you expect and deserve. At the same time Blue Cross gave excessive bonuses to their executives “greater than industry standards” as outlined by an independent consultant group reporting to the Pennsylvania Insurance Commission.”The agreement for Cesare, was not the norm in the industry, according to a compensation consultant referred to by Blackstone.”
Furthermore, the members of the BC NEPA advisory Board are poised to receive Compensation totaling more than $1.1 million. (Click here for articles about the crisis)
If Blue Cross NEPA devoted a fraction of this compensation to increasing our fees we would still be part of their network and you would still be able to receive your care from the doctors you know and trust.
On May 30, 2015 BC NEPA requested a 29.5 % or $53.5 Million Dollar increase in premiums! That is a $1,244 increase per member! (Click here for the Pa Bulletin article) They are asking for higher premiums while reducing your access to quality care!
Our goal is to continue to care for all of our patients. However, Blue Cross was very clear their subscribers don’t need care by Delta Medix and their Network is fine for their members. Please understand it is not the Delta Medix physicians who are sending you to Wilkes-Barre, Lehigh Valley and Danville for your care. It is your insurance, Blue Cross that is dictating that you go to Wilkes-Barre, Lehigh Valley and Danville for your care. They chose to compensate their Executives and Board members handsomely, raise your premiums by double digits annually but make you travel out of the area for care.
From the start, we have received tremendous support from our patients as evidenced by the hundreds of letters sent to BC NEPA requesting they provide access to the care of the Delta Medix specialists. For this we are truly grateful.
Once we became non-participating physicians in the BC NEPA network the only thing we asked of Blue Cross was to be able to continue the care of our patients for ninety days to allow them to transition to another specialist or change insurance carriers to one with which we participate. For us it’s always been about the patient for Blue Cross it has never been about the patient.
The only focus we have now is you, our patient. Unfortunately, the Blue Cross focus appears to have little concern for our patients; paying members. From the moment we became non-participating we agreed to provide ninety days of care and accept the in network fee for any patient under the care and treatment of a Delta Medix physician. We were happy to do this as our patients have always trusted us and value our care. We consistently told our patients they had nothing to worry about as we would continue to care for them until they were able to transition their care to an in network Blue Cross physician or to a carrier with whom Delta Medix participates. Blue Cross publicly said they would honor these Continuation of Care Agreements.
We provided BC with the name of every BC member who had an upcoming visit or procedure scheduled with a Delta Medix physician and notified them under our agreement we would treat these patients as if they were in network. However, on June 1st Blue Cross notified us that only patients scheduled in the period June 2, 2015 through June 15, 2015 would be covered under Continuity of Care Agreement. After that each patient would need to call Blue Cross and request a continuity of care agreement and Blue Cross would notify Delta Medix the patient was requesting continuation of care. Delta Medix would have 15 days to return personal Health information as well as assign a new physician to your care. On five separate occasions we have written to Blue Cross and told them we could not provide personal health information without the authorized consent of the patient, you. We asked them to provide us with the legal documentation that would allow them to have your personal health information released without your authorization. To date, they have not responded nor even acknowledged our request. This puts us and you in a predicament. As it stands they are obstructing us from carrying out your care. We have retained an attorney whose job it is to make sure you are allowed to continue your care with us in the ninety day period. We are diligently working on your behalf to secure a reasonable solution for continuation of your care.
Furthermore, they are asking us to refer you to another physician in the Blue Cross Network without having discussed this with you. This is wrong on multiple levels. First, if you are under the care of a Delta Medix urologist or ENT there are no other urologists or ENTs in Scranton to whom we could refer you. The BC NEPA network only includes urologic and ENT physicians in Wilkes-Barre, Lehigh Valley and Danville. We can't assume that you can travel to Wilkes-Barre, Lehigh Valley or Danville or that you would want to follow up with the physician we may choose for you. We have always shared responsibility for your care with you, the patient. Frankly, we don’t feel comfortable choosing a physician for you without discussing it with you and certainly don’t feel comfortable having an Insurance Company tell you who should provide your care.
The public proclamations made by Blue Cross that they would allow you to continue your care with Delta Medix for a 90 day period appears to be nothing more than a publicity stunt rather than a genuine gesture regarding quality care for their members.
If you are having difficulty getting in to see your Delta Medix physician under the Continuation of Care Agreement we are genuinely sorry. We have no control over this matter. The last thing we want to happen would be for you to see a Delta physician, have Blue Cross deny the care, and leave you with an out of network bill. We will not do that to the patients who have trusted us with their care and the care of their families for generations. PLEASE CALL BLUE CROSS AND INSIST THEY APPROVE YOUR CONTINUATION OF CARE.
We reiterate that First Priority is solely responsible for making all decisions regarding your coverage. Any questions or concerns regarding your coverage should be directed to them. We would suggest that any coverage issues or concerns that remain unresolved be documented in writing and, if necessary, that you consider accessing the appeals and grievance processes provided under your specific health plan. If you have group coverage your employer may also be of help to you.
Please note, we currently participate with over 100 insurance plans. They are all listed on our website.
We will be happy to work with any patient that changes health plans to assure a smooth transition to their new plan. Remember, you are the consumer and any insurance company you choose should be responsive to your needs and not exist for the enrichment of their Executives and Board members.
The Physicians of Delta Medix