Tufts Medical, Blue Cross negotiations break down
Patients face being rejected by doctors Feb. 1
The breakdown in contract talks between Tufts Medical Center physicians and Blue Cross and Blue Shield of Massachusetts has thousands of patients fretting they may not be able to see trusted doctors, and scrambling to come up with alternate caregivers.
Tufts Medical Center and its physicians group Monday said they had been unable to reach an agreement with Blue Cross, the largest health insurer in the state, after 11 months of talks. Unless a solution can be quickly crafted, Tufts doctors will no longer accept Blue Cross members as of Feb. 1.
The hospital's contract with Blue Cross lasts through September. Tufts had sought to renew both at the same time, and for many patients, the inability to see a Tufts doctor effectively locks them out of the hospital.
"I am very, very upset," said Nick Azzolino, 57, who had a heart transplant at Tufts Medical Center in July 2006. Blue Cross "is saying to me if they can't come to terms with the doctors, then I'm on my own. They don't have patient care at the front of their priorities."
Azzolino, who runs a day care center in Carver with his wife, said he spent 10 days in the hospital last month when his body began retaining huge amounts of water. He is scheduled to meet with his cardiologist again Jan. 22.
But when he called Blue Cross yesterday, he said, he was told he could only get an extension to see his doctor for an additional three months - and only if the appointments were set up before the contract terminates at the end of the month.
"These are the people who foster my care," he said. "I need to be with them. If this thing doesn't get resolved, I'm going to have to just get the bills as they come in and submit them myself to Blue Cross."
A Blue Cross spokesman confirmed that HMO patients whose doctors' contracts end this month will have to pay medical bills out of their pocket or seek alternate care. The three-month extension applies only to those HMO members with special medical needs - such as the terminally ill or those with chronic conditions.
After that, "if the physician feels like he or she needs more time with the patients, he or she can call us and we can review it," said Jay McQuaide.
Members of Blue Cross's preferred provider organization, a more flexible type of insurance, can continue to see doctors who are terminated, but will have to pay 20 percent of the bill.
For some, that's not an option.
Elise Gardner of Winchester said she takes her four children to Woburn Pediatrics, a practice that is part of the Tufts doctors group.
"Twenty percent of an office visit is a lot," said Gardner. "Plus we're paying the monthly premium. With four kids, the last thing I want to worry about is my insurance company throwing a tantrum and not playing fair, which is what I try to teach my children."
Talks between Tufts and Blue Cross broke down Monday. The hospital and its affiliated doctors claim they are paid 20 to 40 percent less than comparable teaching hospitals in Boston. Tufts said it is asking for a 9 percent annual pay increase for three years for its doctors, to bring their rates more in line with the other hospitals.
Blue Cross did not dispute that Tufts is paid less.
"We have acknowledged there is an imbalance in rates paid to providers that can be because of market clout," said McQuaide. But Tufts can only get relief, he said, by signing up for the insurers' new payment system, in which hospitals get a basic payment for each patient and can earn additional revenue by meeting quality targets.
Both companies have set up hotlines to field calls from customers. Blue Cross's number is 888-404-9846; Tufts Medical Center's number is 888-953-3763. Tufts also has a website for patients, www.keepmydoc.org.
Jeffrey Krasner can be reached at krasner@globe.com. 