Surgeons dump Blue Cross over rates

Coeur d’Alene’s orthopedic surgeons have joined colleagues throughout Idaho in canceling contracts with Blue Cross after the state’s largest insurer announced it was reducing reimbursement rates for some of the most common orthopedic procedures.

“We attempted to negotiate” with Blue Cross, Dr. Spencer Greendyke said. “They said they were not interested.”

Greendyke is among the state’s orthopedic specialists who have opted out of the Blue Cross network, including preferred provider plans, after the insurer altered its reimbursements rates in December.

A Blue Cross spokesman said payments for some orthopedic procedures were reduced while other payments were raised.

“Overall, our payments are going up,” said Stewart Johnson, public relations manager for Blue Cross in Boise.

But Greendyke said Blue Cross raised reimbursements for rarely performed procedures while it cut reimbursements for the most common procedures, such as knee and shoulder arthroscopy, by 30 percent to 35 percent.

Greendyke said about 10 percent to 15 percent of his patients are covered by Blue Cross.

Joining Greendyke in giving Blue Cross the boot were North Idaho’s largest orthopedic specialist group, Orthopedic Surgery and Sports Medicine, as well as Orthopedic Associates of Coeur d’Alene.

Gail Batchelder, office manager for Orthopedic Surgery and Sports Medicine, also said she tried to negotiate with Blue Cross, but to no avail.

“We feel like we’ve taken enough cuts,” Batchelder said. “They didn’t agree, so we have given them 90 days.” The required three months’ notice runs out July 24.

After that, the office will see Blue Cross patients “out of network,” which means a patient will have to pay the difference between what the doctor and the insurer think is a fair rate.

“It isn’t any small issue for us to say this just isn’t right,” Batchelder said, adding that it was the first time the doctors group canceled an insurer. About 25 percent of her office’s patients are insured by Blue Cross.

Orthopedic specialists in Sandpoint and Kellogg have not joined their Coeur d’Alene colleagues in dropping Blue Cross, but at least 23 other surgeons in Southern Idaho have, according to a report in last month’s Idaho Statesman.

Johnson said the action taken by Blue Cross was justified.

“Our data show us in Idaho we are reimbursing orthopedic specialists considerably higher than we are in surrounding states,” he said.

After the Idaho surgeons leave the network, Johnson said, Blue Cross patients will have access to 42 orthopedic specialists in Spokane.

Greendyke said if Blue Cross cared about Idaho patients, it wouldn’t make them drive to Spokane “to get their routine care.”

The physicians resisting cuts in reimbursements face another challenge next month, when the federal government will reduce Medicare payments for orthopedic procedures by 10.6 percent, to be followed by a 5 percent cut in January.