Blue Cross/Blue Shield Insurance Update
October 5, 2004
Dear families at Pediatric Associates:
Blue Cross/Blue Shield has just informed us that fees paid to Pediatric Associates of Austin and other physicians in the community will be drastically reduced effective January 1, 2005.
Our fee arrangement with Blue Cross/Blue Shield dates back to early 1998. The fees have been based on a relative value scale that has had downward trends in reimbursement each year. However, this reduction is immense. In addition, lab fees have already been reduced substantially and to a point where we may not be able to provide an in-house lab for our patients.
This is a very serious situation for us as a small business. We at Pediatric Associates wish to maintain the high level of care we have provided for over 25 years. Unfortunately, this substantial reduction in fees will make it impossible to continue to provide services in the Blue Cross provider network unless they are convinced to reverse their decision.
Please keep in mind, you will always be able to see your pediatrician here. However, if a mutually agreeable fee schedule cannot be reached, it may be on an out-of-network basis, which will cost you more out of pocket.
If you are in the process of your annual enrollment for medical insurance and you have a choice of health plans, we suggest you look at the list of insurances plans (Click here) for which we are providers. You may want to contact your employer's human resources department as well.
As of today, Blue Cross/Blue Shield has emphatically stated that their fee reduction is not negotiable. You, as the families who pay the premiums for health insurance, may want to convey your feelings to them on this matter. The contact persons for Blue Cross are listed below. Our past experience suggests the only way Blue Cross/Blue Shield will come to the table to negotiate with us will be to have input from our patient base. If we cannot negotiate a favorable contract, we may have no other choice than to terminate our agreement. We would suggest you send an email to both names and cc both on your emails.
Renee Baram, HIA, MHP Becky Gdula
Professional Provider Network Management Provider Relations Manager
(512) 349-4846 phone number (Renee Baram's Supervisor)
(512) 349-4851 fax number Email: becky_gdula@bcbstx.com EMail:renee_baram@bcbstx.comYou may also send the email to Darren Rogers, Senior Vice President, Darren_Rodgers@bcbstx.com and to
M. Ted Haynes VP, Network Management Ted_Haynes@bcbstx.com
If you have questions about this and/or you wish to send us a copy of your Email to Blue Cross you can send it to fightback@pediatricassociates.net
You may be interested in the financial information about Blue Cross/Blue Shield of Texas.
Below is a financial information chart from the Texas Department of Insurance.
Financial Information:
|
As of: |
Dec. 31, 2001 | Dec. 31, 2002 | Dec. 31, 2003 |
|---|---|---|---|
|
Total Assets |
$3,593,230,635 |
$4,160,997,055 |
$4,939,355,480 |
|
Total Liabilities |
$2,412,316,664 |
$2,700,219,348 |
$2,798,519,695 |
|
Asset to Liability Ratio |
1.49 |
1.54 |
1.76 |
|
Capital |
$0 |
$0 |
$0 |
|
Net Surplus |
$1,180,913,971 |
$1,460,777,707 |
$2,140,835,785 |
|
Net Life Ins |
N/A |
N/A |
N/A |
Premiums:
|
As of: |
2001 | 2002 | 2003 |
|---|---|---|---|
|
Life and Annuities |
$0 |
$0 |
$0 |
|
Accident and Health |
$2,053,247,964 |
$2,280,007,448 |
$2,549,007,485 |
|
Property and Casualty |
N/A |
N/A |
N/A |
|
Total Texas Premium |
$2,053,247,964 |
$2,280,007,448 |
$2,549,007,485 |
|
National Premium |
$4,628,734,335 |
$5,555,806,572 |
$6,340,769,243 |
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