BLUE CROSS, HCA FLAP TO AFFECT PATIENT CARE.Byline: Cecilia Chan Staff Writer Roughly 120,000 Blue Cross subscribers are no longer covered for most services at West Hills Hospital and Los Robles Robles is a common surname in the Spanish language meaning oaks, and may refer to:
A four-year reimbursement contract expired Oct. 1 between Hospital Corporation of America The Hospital Corporation of America (HCA) is the largest private operator of health care facilities in the world. It is based in Nashville, Tennessee, United States and is widely considered to be the single largest factor in making that city a hotspot for healthcare and Blue Cross of California, affecting subscribers of its Prudent Buyer (PPO PPO abbr. preferred provider organization PPO Managed care Preferred provider organization, see there Infectious disease Pleuropneumonia-like organism, see there ), CaliforniaCare (HMO HMO health maintenance organization. HMO n. A corporation that is financed by insurance premiums and has member physicians and professional staff who provide curative and preventive medicine within certain financial, ) and Point of Service programs. Subscribers still can go to the hospitals' emergency rooms for treatment, but they will be transferred to other facilities if continued care is needed, officials said. And women in their second or third trimesters of pregnancy can deliver at Los Robles, in Thousand Oaks Thousand Oaks, residential city (1990 pop. 104,352), Ventura co., S Calif., in a farm area; inc. 1964. Avocados, citrus, vegetables, strawberries, and nursery products are grown. , or at West Hills, but those in only their first trimester must make other arrangements. ``If you go to a doctor now for surgery to be done, you'll have to chose another medical center unless you want to pay out of pocket, which is thousands and thousands of dollars,'' Los Robles spokeswoman Kris Carraway-Bowman said. Blue Cross also will cover patients approved before Oct. 1 for elective or nonemergency surgery at HCA HCA, n.pr See acid, hydroxycitric. hospitals, but the procedure must be completed this month. ``For all other services, Blue Cross members need to talk to their physicians about where they are admitted,'' HCA spokeswoman Leslie Kelsay said. ``And if their physician is not on the medical staff of the other hospital, they may have to chose another physician, as well.'' For patients undergoing continued treatment - such as chemotherapy or kidney dialysis Dialysis, Kidney Definition Dialysis treatment replaces the function of the kidneys, which normally serve as the body's natural filtration system. - Blue Cross will decide coverage on a case-by-case basis, Kelsay said. Subscribers who previously would have been treated at West Hills have the option of receiving care at Valley Presbyterian Hospital, Granada Hills Community Hospital or Encino-Tarzana or Northridge Hospital medical centers. The alternatives to Los Robles are Simi Valley Hospital Simi Valley Hospital (SVH) is a Seventh-day Adventist hospital located located in Simi Valley, California. SVH is a member of Adventist Health. New Construction Simi Valley Hospital is in the process of building a new wing to the hospital. or St. John's Regional Medical Center St. John's Regional Medical Center may refer to: In the United States:
Both sides blame the other for the stalemate in reaching a new reimbursement contract. ``We were very close to reaching an agreement,'' Blue Cross spokesman Michael Chee said. ``We worked out the terms and they simply walked away from the table. ``They have taken the unfortunate and unnecessary step of disrupting members' care for absolutely no reason,'' he said. ``We can't account for HCA's behavior.'' Kelsay said both sides disagreed with the length of the new contract and reimbursement rates. ``All the other health insurance plans we have contracts with have a one- year term because the cost increase in health care is so volatile, it's impossible to predict year to year,'' she said. ``Blue Cross initially required a three-year contract. We were willing to consider a two-year contract if other terms were appropriate. ``But finally, what it came down to is what Blue Cross was willing to offer to pay the hospitals to provide health care service to Blue Cross subscribers does not adequately reflect the cost of those services.'' ``Blue Cross was the lowest payer for health care services to our hospitals,'' Kelsay said. ``Blue Cross was paying less than Medicare rates. And the Blue Cross rates Cross rates The exchange rate between two currencies expressed as the ratio of two foreign exchange rates that are both expressed in terms of a third currency. Foreign exchange rate between two currencies other than the US dollar, the currency in which most exchanges are usually quoted. that Blue Cross was paying would have to almost double to bring them up to the next-lowest private health plan. Chee called Kelsay's comments ``false and misleading.'' Both HCA and Blue Cross said it is up to the other side to make the next move to end the stalemate. |
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