Nashville, Tenn.-based Anesthesia Medical Group, which comprises about 120 physicians and 400 anesthesiologists, is slated to go out of network with BlueCross BlueShield of Tennessee if the organizations fail to resolve a dispute over reimbursement rates, according to the Nashville Post.
AMG and BCBST have maintained a contract for more than 22 years; however, that's set to change as Stephen Santi, MD, president of AMG, said BCBST recently requested a 15 percent payment cut. In May, AMG countered that offer with a smaller adjustment. BCBST responded by demanding a 25 percent cut for services performed in 220-plus operating rooms at 33 facilities in Middle Tennessee. These facilities include Brentwood, Tenn.-based TriStar Health System hospitals, Franklin, Tenn.-based Williamson Medical Center and Gallatin, Tenn-based Sumner Regional Medical Center.
Dr. Santi told the Nashville Post the proposed cut won't work. "We have a number in mind that is viable for us. We definitely want to go back to the table. We have a feel for what the market is because we've gone through this with three other insurers" in the past 18 months, he said.
BCBST officials argued they're seeking a fair rate for AMG, employer groups and plan members. The insurer said it also has struck new deals with other Tennessee anesthesiology groups. "We know that, unless we draw the line on the cost of medical services, our members will be the ones who suffer," BCBST said.
Caught in the middle are thousands of patients would could see an uptick in surprise or balance bills from treatments they receive at hospitals or facilities in the BCBST network. The organizations have until Sept. 1 to negotiate a new agreement.