Integris, Blue Cross/Blue Shield of Oklahoma have less than a month to settle dispute before patients feel effects
Oklahoma City — Some patients who get their care at Integris are scrambling to find other options as the hospitals and Blue Cross and Blue Shield of Oklahoma remain locked in a contract battle.
Sharon McDonald, of Guthrie, said she wants to stay with the Integris doctors who have managed her melanoma and related conditions since 2015, but will be forced to find another provider if BCBS and Integris can't come to an agreement. She said she has looked into transferring to Stephenson Cancer Center, but the hospital doesn't accept all patients, and she'd rather stay with the providers she knows.
“They know every little thing that messes me up, so they don't give it to me anymore,” she said. “Everybody's body reacts differently to cancer.”
BCBS customers still could go to an Integris facility even if they don't reach an agreement, but would be charged a higher rate for out-of-network care. McDonald says that's not something she can afford, particularly since the effects of her cancer treatment forced her to stop working.
“I'm already pushed beyond my limits financially,” she said.
McDonald has undergone surgery, radiation, immunotherapy and chemotherapy to beat back the cancer. She's in remission now, but needs scans every three months to see if the melanoma is spreading again. The contract between BCBS and Integris will continue until Aug. 31, but she may have to transfer before then, if this week's scan shows she needs to restart treatment.
“If I'm clear, I have some time to decide,” she said. “If I'm not clear, I have to decide in the next week.”
The negotiations would affect only some BCBS customers: those with Medicare Advantage plans, and those in the following commercial plans: Blue Traditional, Blue Choice PPO, Blue Preferred PPO and BlueLincs HMO.
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The original contracts have expired, but the hospitals and BCBS agreed to extend them until the end of the month. A separate contract with about 600 physicians and other providers will end Oct. 24. Both BCBS and Integris said they were conducting good-faith negotiations toward new contracts.
Not all physicians who work at Integris are leaving the network, however, so customers would have to look up their specific doctor to know if they might need to switch. Patients who get home health care, medical equipment, or infusions from Integris also will need to check on whether their care will remain in-network, according to Integris.
Patients with certain conditions also might not have to choose immediately, according to a statement from BCBS. Pregnant women, for example, might be able to continue seeing their current doctor and give birth at Lakeside Women's Hospital without paying extra charges. People with disabilities and life-threatening conditions also might be able to get an exemption to continue seeing the same providers.
An exemption isn't guaranteed, though, so BCBS members will need to call the customer service number on their cards to check before racking up medical bills.
Patients will still have access to Mercy Hospital, St. Anthony Hospital and University of Oklahoma Medical Center, among other facilities, according to BCBS. Customers who need to find a new provider can look up their options online at www.bcbsok.com/find-a-doctor-or-hospital, and search by their plan, provider type and location.
Some patients worry that they may not find doctors who understand their needs, however. Kevin Walker, of Oklahoma City, sees a pulmonary specialist at Integris Southwest Medical Center for a rare genetic disorder that has caused his lungs to collapse in the past. While his last surgery was in 2013, he still needs regular checkups and treatments to improve his lung function, he said.
“My medical file's pretty thick,” he said. “It's not something you can read over in one fell swoop.”
Many physicians aren't familiar with his condition, Birt-Hogg-Dubé syndrome, Walker said, which would make it difficult to just transfer to another doctor. The National Library of Medicine estimates his condition has been found in only about 400 families, so many physicians will never see a case.
Walker said he's frustrated with both BCBS and Integris for letting the dispute go on.
“It's to the point that it's asinine that they're in a feud right now over money when they're both making money,” he said. “It's money over lives.”