Southcoast threatens to end contract if Blue Cross doesn’t agree to rate increase

PROVIDENCE – A standoff between Southcoast Health System, Southcoast Hospitals Group and Blue Cross Blue Shield of Massachusetts could result in loss of access to the southeastern Massachusetts health care network for thousands of patients.

Southcoast Health is threatening to terminate its contract with Blue Cross Blue Shield on Jan. 1 unless the insurance company agrees to a rate increase of 30% over the next four years.

Blue Cross Blue Shield, which covers between 60,000 and 80,000 Southcoast patients, has countered by offering a 12% rate increase over the same time frame, according to the Boston Business Journal.

“We value the care that Southcoast physicians and hospitals provide to our members,” Blue Cross Blue Shield said in a statement. “But on behalf of our customers, we cannot agree to rate increases that will make quality health care less affordable.”

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In an open letter published Monday in a Wareham, Mass., newspaper, Southcoast Health CEO and President Keith A. Hovan took aim at Blue Cross Blue Shield, accusing it of valuing revenue over patients.

“We need our insurance partners to reimburse us fairly in the marketplace. Our community and clinical investments more than justify that we be reimbursed equitably with comparable community health systems in the commonwealth,” Hovan wrote. “Equal, and in many cases superior, quality and service should merit equitable compensation.”

If the two sides don’t reach an agreement, Blue Cross Blue Shield customers will not have access to in-network coverage for care at Southcoast hospitals, clinics and its visiting nurse program. Emergency room visits are the exception, Hovan said in the letter.

Failure to renew a contract will mean extra travel time for Blue Cross Blue Shield customers in need of medical care, or out-of-pocket costs for patients who opt to continue seeing Southcoast providers, he added.

Southcoast Health includes St. Luke’s Hospital, Tobey Hospital, Charlton Hospital and numerous outpatient, primary care and urgent care clinics in southeastern Massachusetts.

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