Patients undergoing non-emergency surgeries — including births — may see out-of-pocket costs skyrocket due to a standoff between BlueCross BlueShield of Tennessee and Nashville, Tenn.-based Anesthesia Medical Group, The Tennessean reports.
Here's what you should know:
1. BlueCross plans to remove AMG from its coverage network if the companies can't agree on new insurance reimbursement rates by Sept 1.
2. AMG is Tennessee's largest anesthesiologist company. AMG anesthesiologists work in most TriStar, Saint Thomas and Tennova hospitals and their outpatient surgery centers. TriStar and Saint Thomas are based in Nashville, and Tennova is based in Knoxville, Tenn.
3. BlueCross Senior Vice President Roy Vaughn said AMG proposed an increase while BlueCross seeks a decrease. However, AMG Chairman Dr. Stephen Santi claims his company proposed a rate decrease and BlueCross demanded a larger decrease.
4. If negotiations fail, BlueCross beneficiaries with surgeries scheduled at affected facilities have three options: Request an exemption that would treat AMG anesthesiologists as in-network; seek discounts AMG said it would consider on a case-by-case basis; or try transferring the procedure to an in-network hospital.
5. The coverage loss could impact women who give birth at affected hospitals. An epidural — which would be performed by an AMG physicians at nearly every Middle Tennessee hospital — can cost upwards of $3,000.
6. The change wouldn't impact anesthesia for emergency care or coverage from TennCare or Medicare.