About 20 members of Western’s faculty and staff met with an official from the Bowling Green Medical Clinic yesterday to voice concerns about BGMC dropping out of Anthem Blue Cross and Blue Shield’s insurance network.
Anthem’s network is the group of health care providers that customers can go to for a discounted rate.
Western and Anthem officials were invited to the meeting, but didn’t attend, said Deborah Logan, an English professor who organized the meeting.
Logan said employees at the meeting wanted to find out why BGMC dropped out of the network and why they hadn’t been told about the change sooner.
Anthem is an insurance option for all Western employees, and they can still go to BGMC, but they will pay a higher fee, the Herald reported.
About 360 Western employees use BGMC as their primary care provider, said Faculty Regent Patricia Minter, who represented Western’s benefits committee at the meeting.
BGMC dropped out of Anthem’s network because Anthem officials wanted to reimburse BGMC doctors about 23 percent less than what Medicare reimburses them for services, said Jolene Lovett, practice manager for BGMC.
She said that accepting a lower reimbursement amount from Anthem than from Medicare would have violated the clinic’s contract with Medicare.
Western officials found out on Oct. 3 that BGMC had dropped out of the network when a Western employee told them that there was a sign posted at the clinic, Minter said.
Minter said human resources isn’t to blame for not informing employees about the change because they weren’t involved in discussion about an agreement.
“The finger pointing at WKU and HR really should be put back in their hands,” Minter said of employees complaining to Western officials about not being informed of the change.
Anthem is Western’s third party administrator, she said.
They bill the health care provider and negotiate prices for the care, the Herald previously reported.
Lovett said it’s Anthem’s responsibility to inform their customers about changes in the network.
Tony Glisson, director of human resources, said he sent an e-mail to faculty and staff on Oct. 10 when Anthem and BGMC officially announced that they hadn’t reached an agreement.
Christi Lanier-Robinson, public relations director for Anthem, said Anthem officials thought they would reach an agreement with BGMC officials, so they delayed notifying customers about the change.
She said Anthem officials offered that reimbursement amount to prevent raising the cost of insurance.
Lovett said clinic and Anthem officals aren’t currently discussing an agreement.
“So basically, game over,” she said. “But it’s no game – it’s health care.”
Lovett said insurance companies tell health care providers that they are going to change in their reimbursement amount 90 days before they make the change.
She said the health care provider then decides if they will accept that amount.
If they do, then the change happens after 90 days, and if they don’t, then they drop out of that company’s network, Lovett said.
Lanier-Robinson said the discussion between BGMC and Anthem officials could start again.
Reach Christina Howerton at news@chherald.com.
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