Johns Hopkins warns it may split from CareFirst, Maryland’s largest insurer – Baltimore Sun

Doctors at Johns Hopkins hospitals, surgery centers and community physician offices may soon no longer accept insurance from one of the state’s dominant insurers, CareFirst BlueCross BlueShield, limiting access or raising costs for some of the area’s most sought-after medical providers.

Johns Hopkins and CareFirst BlueCross BlueShield have so far failed to reach agreement on the portion of patient bills that goes to physicians, other providers and possibly other fees, albeit not for direct hospital services.

Hopkins began notifying 350,000 regular and modern patients today by email or through the US Postal Service that they may no longer be “in the network” as of December 5, although anyone with CareFirst insurance may be affected.

“Hopkins, and I think CareFirst is committed to serving the community in which we live and the citizens of Maryland, but when I step back and put on my financial hat, I need to make sure we have a sustainable business model,” said Kevin Sawers, president of Johns Hopkins Health System and executive vice president of Johns Hopkins Medicine.

In a statement to The Baltimore Sun, CareFirst officials also said they are working to find a solution before the contract expires, and have not noticed any change to beneficiaries for the 90-day period. They also said Hopkins had begun terminating the contract.

“We regret Johns Hopkins’ decision to terminate our existing contracts and disagree that it was necessary to place the people we serve collectively in the middle of ongoing negotiations,” the statement read. “As we continue to discuss how best to improve access, affordability, quality, and equity in healthcare together, our shared commitment to the community and long history of collaboration give us hope that our partnership will continue.”

Both sides said rising costs are a problem. When he began looking at contracts with all of Hopkins’ major insurers, Sawers said, he found that the cost of providing health care had risen 21% over the past decade, but that CareFirst’s rate increase was only 10%. He said CareFirst was also paying less than other insurance companies.

CareFirst said Hopkins was asking for price increases beyond the rate of inflation. CareFirst also said that it might be unfair to compare it to other large insurance companies because, unlike CareFirst with a wide range of services across Maryland, other large carriers are out-of-state for-profits that can “pick and choose which communities they serve.”

Sawers said he was obligated by law to give CareFirst 90 days’ notice that Hopkins doctors would go out of the network, though he said his “hope and goal” remained to settle a new contract. He referred to the “transparency” in the decision to send messages to patients alerting them to the possibility of ending coverage within the network, Answer the essential questions Create a special call center. It will be open from 8 a.m. to 5 p.m. on weekdays at 443-997-0549.

A patient letter to The Baltimore Sun begins: “Because you are a patient at Johns Hopkins Medicine, your health is our top priority. That’s why we need to inform you that Johns Hopkins physicians, nurses, and caregivers may have to leave the CareFirst Network as soon as December 5, 2022. As a result CareFirst may or may not cover less of the care you receive at Johns Hopkins starting December 5, 2022, leaving you paying more to see your doctors, nurses, and caregivers.”

Specific costs for patients depend on a person’s insurance policy, which complicates answers about exactly what will be covered. Some plans cover a portion of the out-of-network costs while others don’t cover anything. The letter to patients advised them to call the number on the back of their CareFirst insurance card with questions about coverage.

Another complication is that costs also depend on where the person received care.

The state sets rates for direct hospital services under a unique agreement Maryland has with the federal government as a way to improve health care and control costs. Unlike other states, hospital officials in Maryland do not negotiate this, and all public and private insurance companies pay the same price at a particular hospital.

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This system is why patients often receive more than one bill for a hospital visit.

If the contract expires, care provided at hospitals, including Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center in Baltimore, will remain in the network. This will likely include fees for laboratory work and accompanying facilities, provided it is performed in a hospital.

For the most part, doctors and other providers in those hospitals would be out of network if a patient saw providers in the hospital or was admitted. Physicians in the emergency room are exempted as per the rules in Maryland. They will remain covered.

Physicians in surgery centers and community physician offices will be out of the network, potentially along with labs and other fees associated with out-of-hospital care.

Those receiving ongoing treatment for cancer or any other condition that requires ongoing care can request approval from CareFirst to continue those treatments at Hopkins at in-network rates.

Collectively, Johns Hopkins Medicine has more than 2.4 million patients and 280,000 emergency room visits annually, according to its website.

CareFirst reports that it has 3.5 million members in the Mid-Atlantic region and has access to 1.7 million providers.

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