The doctors’ group whose members staff the emergency rooms at Rhode Island Hospital, Hasbro Children’s Hospital and The Miriam Hospital has bowed out of the Blue Cross & Blue Shield of Rhode Island network, effective Jan. 1, saying the insurer pays too little.
As a result, Blue Cross subscribers treated in those ERs will have to pay for the doctors’ service out of their own pockets, minus their out-of-network benefit. The rest of the services – from nursing to tests, radiology and medication – will still be covered as before.
But even if the impact on individual patients is several hundred dollars apiece, the doctors’ move, affecting the state’s only Level 1 trauma center, its prime pediatric ER, and a major community hospital, was shocking news for the health care industry.
The University Emergency Medicine Foundation, as the doctors’ group is called, issued a news release saying that it was leaving the Blue Cross network after being unable to reach a contract “that recognizes the cost and value of emergency services.”
Rhode Island has a shortage of emergency physicians, the group noted, and in the last two years alone, the group has lost almost 20 percent of its doctors.
“We had hoped that our contract negotiations with Blue Cross would not have reached this point, but we must remain competitive within the emergency medicine field,” Dr. Robert Woolard, president of the group, said. “The citizens of Rhode Island deserve and expect high-quality emergency physicians, and we must attract them.”
But Kim Keough, spokeswoman for Blue Cross, said the doctors wanted to earn 75 percent more than what the insurer pays the other 150 ER physicians in its network, and that wasn’t acceptable. Now, she noted, they can charge “whatever they want,” and patients will be the ones who pay. “We didn’t want to see this happen,” she said.
