Everything About Insurance Claims

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The acquisition by the Tulsa-based network of hospitals, clinics and physicians was announced in February and finalized Saturday. BCBS officials, in the online alert that was removed Wednesday following media inquiries, attributed the problems to a decision made by Saint Francis to reject reimbursement rates previously accepted by EASTAR. That decision resulted with Saint Francis Hospital Muskogee and its physicians being removed from the insurers network of providers, but the situation began to shift Wednesday. At this time, Blue Cross and Blue Shield of Oklahoma is engaged in confidential negotiations with Saint Francis with the intent to protect our members in the Muskogee community, spokeswoman Lauren Cusick said.

We are unable to comment further. Saint Francis officials acknowledged in their statement that they continued to be engaged in confidential negotiations but were unable to provide additional information at this time. Local health care consumers began sharing concerns after learning they might have to find new primary care providers or travel to hospitals outside Muskogee to secure in-network savings offered by their insurance plans. Ronnie Ball said he learned about the situation when he went to a scheduled doctors appointment to get a report from lab work that had been done earlier. Ball, who has coverage through the Blue Cross Medicare Advantage PPO plan, said he learned after he arrived his insurance would not be accepted because his physician was no longer considered an in-network provider as a result of the Saint Francis-EASTAR deal. That leaves me … without a local hospital to go to unless I want to risk paying out-of-network costs or maybe having to pay 100 percent of the costs, Ball said. I wonder what was behind this decision now that there may be thousands of people in the Muskogee area who no longer have insurance coverage with local doctors or if they do they are out of network. Cusick was unable to provide information about how many people in the Muskogee area might be affected by Saint Francis decision if there is no breakthrough in the renewed negotiations. There was some indication, however, the impact could be significant. Marie Synar, interim director of Muskogee City-County Port Authority’s Industrial Development Office, said nine local manufacturers provide health insurance through BCBS plans to more than 600 employees.

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