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BLUE CROSS FAIR-PAYMENT PROVISION AIMED AT LOWER COSTS FOR CUSTOMERS

 PITTSBURGH, May 4 /PRNewswire/ -- A fair-payment clause in the proposed contract between Blue Cross of Western Pennsylvania and the region's hospitals is designed to get the best rates possible for Blue Cross customers, according to a Blue Cross executive.
 Dean Eckenrode, Blue Cross vice president of provider reimbursement, said today that the fair-payment provision would help protect Blue Cross customers from rising health care costs.
 He was responding today to concerns raised by Pennsylvania Attorney General Ernest Preate Jr. "We believe Mr. Preate doesn't have a clear understanding of our fair-payment approach," Eckenrode said. "His concerns should be alleviated after we've had an opportunity to discuss this with him."
 Eckenrode explained that the fair-payment concept is based on a common business principle: if Blue Cross is the largest volume private payer at a given hospital, then Blue Cross should pay a price at least as favorable as any other purchaser, including local HMOs.
 "It's only fair that Blue Cross customers enjoy the advantage of at least the same price a hospital charges another insurer -- as long as Blue Cross customers represent the hospital's largest group of private patients," he said.
 Unlike other insurers, Eckenrode said, Blue Cross offers coverage to everyone, regardless of medical history, and to all groups, regardless of occupation. He also pointed out that Blue Cross offers subsidized coverage to persons who are not part of a group, and special low-cost coverage to low-income families, and free primary care coverage to children of low-income parents.
 He said that companies such as certain for-profit health maintenance organizations selectively contract with hospitals solely on the basis of cost. "These companies avoid hospitals that offer advanced medical training and specialty care. HMOs that don't contract with these hospitals are in effect calling on Blue Cross customers to subsidize the community health care system -- while at the same time denying their members the opportunity to get care at these advanced-care hospitals."
 Eckenrode said the fair-payment clause will help most Western Pennsylvanians, who have Blue Cross coverage. "At a time of escalating health care costs, and calls for health care reform, it's crucial that we do whatever we can to keep costs down for our customers," Eckenrode said.
 -0- 5/4/93
 /CONTACT: John McDermott of Blue Cross of Western Pennsylvania, 412-255-8247/


CO: Blue Cross of Western Pennsylvania ST: Pennsylvania IN: HEA SU:

CD-CC -- PG020 -- 2141 05/04/93 18:27 EDT
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Publication:PR Newswire
Date:May 4, 1993
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