12/30/13 — School employees affected by insurance stalemate

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School employees affected by insurance stalemate

By Phyllis Moore
Published in News on December 30, 2013 1:46 PM

Wayne County Public Schools employees are among those feeling the fallout from the impasse in negotiations between insurance provider Blue Cross Blue Shield and Wayne Memorial Hospital.

Efforts of the insurance carrier and the local hospital to reach an agreement in costs and services broke down in September after 18 months of talks, but resumed in October in hopes of reaching resolution before the deadline of Dec. 5.

That did not happen, though, and the decision to terminate the contract with Wayne Memorial means the hospital is an out-of-network provider for all Blue Cross Blue Shield of North Carolina customers except those with Blue Medicare, with temporary continuity of care agreements and those receiving emergency care.

The school district has been fielding almost daily calls from employees concerned about what that will mean for them, said Ken Derksen, director of communication services.

"Many are calling with questions, curious," he said. "They want to understand how it's going to impact them and their families."

The short answer is that the school district doesn't administer the health plan, Derksen said. That is done through the state health plan.

"We can answer general questions," he said. "But all the policyholders have received letters from Blue Cross Blue Shield. Those with identified health issues, they have also received individualized letters from Blue Cross, giving guidance to those policyholders, giving them the list of neighboring hospitals, the ones in-network, where to contact them."

The school system is one of the largest employers in the county and as such, has kept a close eye on the insurance concern, Derksen said.

"The district has 2,200 employees, 2,205 to be exact, that are impacted by this," he said. "As far as the number of dependents (insured) we don't have that number, which would make the number even higher.

"I think the biggest thing, we have received several calls from employees every day. Some are just curious of how this is going to impact them."

Whether the issues are managing co-pays or having to duplicate tests because of the changeover, Derksen said the bottom line will be continuity of care.

"Say you're pregnant in the third trimester, you're guaranteed in-network care," he said. "If you're in some type of treatment plan, some health problem that has already been identified, such as cancer, you may be able to be placed in-network.

"The biggest thing that employees are going to have to do is pre-plan their care."

While those covered under BCBS may have to pay out-of-network at Wayne Memorial, it's also possible they will have to consider going to a hospital or a physician in another county because their primary care doctor may not have privileges at that hospital, Derksen said.

"You're going to have to really manage your plan and manage your care," he said. "This is going to be that extra step they're going to have to take when you know you have to have some type of treatment."

Derksen said the recent turn of events was unfortunate.

"It's fair to say the school district was disappointed when negotiations broke down," he said. "That's going to be frustrating. We're disappointed in general that the negotiations fell through because our employees need health care.

"We have many qualified and highly qualified physicians here in Wayne County. But for some employees, for those that are pre-planning care, they may have to go to another county."