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Blue Cross, Spalding Regional at impasse

As of June 30, Spalding Regional Medical Center may be considered ‘out of network’ for those insured by Blue Cross Blue Shield of Georgia. SRMC is circulating the following information to area chambers of commerce for distribution to members. Dear Chamber of Commerce Member: I’m writing to you with important information about Spalding Regional Medical Center’s relationship with Blue Cross and Blue Shield of Georgia. Blue Cross has notified local subscribers that the current contract with Spalding Regional is scheduled to end on June 30, 2010. I wanted to ensure you have the information you need in case you get questions from your employees. For the last six months, we have made significant efforts to reach an agreement so that you and your employees can continue to have access to affordable, quality healthcare. Today, Blue Cross pays Spalding Regional far less than other private insurance companies and in these negotiations they have been unwilling to compromise despite third-party data that validates our position. These low payment rates are simply not sustainable for us to have the resources we need to invest in quality care for the community. As one of the county’s largest employers, we know healthcare costs are top of mind for you. Throughout this negotiation, we have worked to identify a compromise that will benefit both organizations and keep costs lower for you and other employees. In an effort to retain these lower costs, we are willing to accept a percent increase to the hospital’s payment capped at the average premium percent increase for all employers, including you. This seems fair, and it demonstrates our commitment to helping slow the growth in premiums and overall healthcare costs. Unfortunately, Blue Cross has refused any further compromise. This means after June 30, 2010, Spalding Regional will be considered out-of-network for all Blue Cross products. By failing to negotiate in good faith, Blue Cross is putting you and your employees’ ability to access care at Spalding Regional at risk, limiting the ability to receive quality care. Let us assure you that if your employees have an emergency, they can still access Spalding Regional’s emergency room no matter what the outcome of the negotiations. However, this may mean additional out-of-pocket costs to you and your employees for both emergency and non-emergency care received at your local hospital We encourage you to contact Blue Cross or your health plan administrator for specific information on your coverage. Our hospital is committed to providing quality care to our patients, as evidenced by our high scores in key, nationally recognized quality indicators. We provide the quality, affordable care you deserve, and need Blue Cross to have that same commitment. We recognize that this is very disruptive for our patients, our physicians, your employees, and our community, but it is important for you to know that we take anything that prevents patient access to care very seriously. We would not take these steps if they were not absolutely necessary. There are several ways for you to get involved: 1. Contact Blue Cross and Blue Shield of Georgia directly and tell them you want access to our hospital. A plan without Spalding Regional Medical Center is not the plan that you purchased from Blue Cross, and not what you deserve. Blue Cross will listen to employers because you pay expensive premiums each month. Monye Connolly’¨President, BCBSGA’¨(404) 842-8509. 2. Evaluate your plan or talk with your broker to ensure that you will have in-network access to Spalding Regional after June 30, 2010. 3. Share this information with your employees. They need to know what’s going on and will look to you for answers about their health coverage. We remain hopeful that we will be able to reach an agreement that will allow our hospital to stay in the Blue Cross provider network and not disrupt care for you, your employees, and the community. We will be sure to keep you updated as we get closer to June 30. In the meantime, if you have questions, please contact me at 770-229-6469 or John.Quinn@tenethealth.com.

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