Fight for What Really Matters

On July 5, Children’s Hospital in Minnesota and an insurance company, Blue Cross Blue Shield of Minnesota, decided to terminate their relationship. By terminating this relationship, numerous families have to decide where else to obtain the quality care they need or incur a financial burden, as Blue Cross Blue Shield of Minnesota will be out-of-network when using Children’s Hospital as a provider.

After reading news-article-after-news-article about this termination, one thing that is never mentioned in the press releases from these companies is the families that are affected. Children are diagnosed with various illnesses, obtain treatment, and oftentimes need continued treatment at Children’s to live a long, healthy life. Parents should not have to choose between the health of their child and worry about having to pay the medical bill associated with this treatment. If a family has had their whole medical journey after a traumatic diagnosis at Children’s Hospital, why would they want to establish a whole new history with a different location, different doctor, etc.?

After the relationship was terminated and made public, both utilized their public relations skills by trying to positively spin the situation and make their side look like the hero. Blue Cross Blue Shield stated they find it disappointing Children’s would choose to walk away instead of working out a new agreement. They then offered options of transferring to numerous other speciality hospitals in Minnesota that are in-network. However, the number of patients utilizing Blue Cross Blue Shield at Children’s Hospital is so high, the other providers offered lack the capacity to treat these patients. Children’s Hospital countered the blame by stating the insurance company provided impossible ultimatums and Blue Cross Blue Shield would have provided double digit reductions to Medicaid rates. These reductions would negatively affect all patients as Children’s would have to have other means to come up with the funds necessary to treat patients.

I will admit, I have little knowledge of the relationship between insurance companies and medical providers. No matter how much I try to learn more about this relationship. I can not wrap my head around why insurance companies can’t pay for the services that are billed for a particular service. Every medical provider has a set of medical codes they have to bill to in order for the insurance company to recognize the service that was performed. These codes should have the same pay rate across the board. Insurance companies and medical providers should not have to negotiate how much will get paid out on these codes based upon a contract and then incur a write-off loss when the whole amount isn’t paid out. Since there is such a varying amount of payouts based upon the type of insurance plan a patient has, providers need to continually juggle the various insurance companies and negotiate better reimbursement rates to offset the companies and types of plans that don’t pay as well.

I’m not naïve. I know both sides want to make a profit and each side will do what they can to stay profitable, especially when there is such a varying amount of pay-outs for medical services. Families should not have to obtain subpar medical care, or have restrictions regarding who they can get medical services from because their insurance company won’t cover the services. In this case we are talking about the lives of children. Children who have been dealt an unfortunate, out of their control crisis, and the families that have to incur the additional stress associated with keeping their child healthy and in some cases, alive. However, this problem applies to every human being.

Throughout the United States, medical providers, nursing homes, hospitals are all not getting paid the amount needed to sustain and assist people that need help. Insurance companies have restrictions on where a person can go to minimize the financial burden to the patient, but this increases the financial burden to the medical provider themselves in turn. At what point is human life more important than profit?