Our Opinion: Health care dispute traps Berkshire insured
A substantial number of Berkshire County residents are experiencing the considerable pain that is routinely caused by a money-driven health care system. This in a state that is actually a health care pioneer.
Starting on May 15, Boston Medical Center HealthNet will no longer cover medical expenses incurred at Berkshire Health Systems facilities (Eagle, April 26). BMC HealthNet notified its clients, numbering roughly 12,000, in a letter dated April 15 of its decision, which will force them to either change carriers or pursue medical care elsewhere in a facility still affiliated with BMC HealthNet.
BMC HealthNet threw BHS under the bus to The Eagle, asserting that it was losing money because BHS care is among the most expensive in the state and it could not negotiate a better reimbursement rate with the Pittsfield-based company. For good measure, Kevin Klein, the chief marketing and sales officer for BMC HealthNet, declared that BHS made $14.5 million after expenses in 2014. For whatever it is worth, both of the companies are technically nonprofits.
Darlene Rodowicz, chief financial officer for BHS, counters that the cost of services at BHS facilities, according to state and federal data, is average or below average in most categories, adding that reimbursement rate reductions were granted BMC HealthNet by BHS. It is her contention that the Boston company is losing money because of reductions in state funding.
The welcome reforms of the Affordable Care Act aside, the absence of a federal government-run health care system inevitably produces this kind of mess. The financially strapped state doesn't have the resources to reimburse BMC HealthNet at equitable levels, leaving it to cancel coverage. It and health care providers are then reduced to firing numbers back and forth in the ensuing public relations battle.
Caught in the crossfire are the insured, or formerly insured, many with serious health care issues. Traveling out of the highway-challenged Berkshires to receive health care is difficult and time-consuming, and Berkshire HealthNet's cancellation of its relationship with BayState Health Systems — which it also branded as too costly — eliminates one option. We'd like to think a compromise can still be reached. Failing that, BMC HealthNet and BHS should work together to find alternative coverage for the thousand of impacted residents.
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