Outpatient Surgical Center can't reach deal with Blue Cross

Starting this fall, local residents with Anthem Blue Cross health insurance who need an outpatient surgery will likely have to find treatment outside the city.

The Lodi Outpatient Surgical Center announced earlier this week that it was unable to come to terms with Blue Cross. The center's current contract with the insurance provider will end Oct. 15.

Lodi Memorial Hospital has been in a stalemate with Blue Cross since April of 2007.

Residents with Blue Cross can still receive treatment at Lodi Memorial and the outpatient center but they should be aware that the insurance company will likely not cover most of the costs.

Marklin Brown, the surgical center's administrator, said Blue Cross "is a very tough negotiator" and wanted a much lower rate for its reimbursements to the clinic.

"The premiums are high but their reimbursements to provider are not and it's time they see the light and start moving more money to their providers," Brown said.

Brown suggested residents find out-of-town providers or choose another health insurance plan.

Brown said the clinic, located a few blocks away from Lodi Memorial, provides outpatient procedures such as cataract surgery, urological procedures and colonoscopies.

In an e-mail statement, Blue Cross spokeswoman Peggy Hinz said her company will continue to try and reach agreements with the surgical clinic and the hospital.

"We continue to negotiate with the Lodi Outpatient Surgical Center and are hopeful that we will reach a mutually acceptable agreement," she said. "Our goal in all contract negotiations is to provide adequate reimbursement to the quality medical facilities in our network, while keeping costs as affordable as possible for our Anthem Blue Cross members."

Hinz said even though there is no contract with Lodi Memorial, Blue Cross continues "to negotiate in good faith" and "remain hopeful that we can work together to reach an agreement with them."

Reader Feedback

Cogito wrote on Jul 13, 2008 1:21 PM:

" Robb, OMG, a company in business to make profit? How HORRIBLE! Who do you work for? I guarantee they make a profit, otherwise they couldn't pay you a salary. Now YOU can understand and "move on". "

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Cogito wrote on Jul 13, 2008 1:16 PM:

" Being forced to seek medical care outside of Lodi? Talk about your blessing in disguise! "

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Robb wrote on Jul 12, 2008 9:59 PM:

" Of course, this is to be expected... Insurance companies are in business to MAKE money, not cover bills, as soon as people realize this truth, they can move on..... "

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Scrutiny wrote on Jul 12, 2008 8:50 PM:

" Ya T&c, 12 bucks for a couple Tylenol is a pretty standard charge for LMH, but hey, that includes a plastic, (and nonrecyclable) cup full of water. "

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T&c wrote on Jul 12, 2008 3:40 PM:

" I say boycott Lodi Memorial. If they're a non-profit, why are they not accepting BC/BS? Judy, have you seen the high priced billings from the hospital to the providers? This greed indeed does work both ways. "

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judy wrote on Jul 12, 2008 9:20 AM:

" The cost of health care in this country is a sad commentary on what we have become. Most insurance companies only care about their profit margin, not the health of their subscribers. The cost of greed is high..... "

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Giovanina wrote on Jul 12, 2008 9:07 AM:

" Doesn't matter as more illegals are moving to Lodi. It won't be long before Lodi Memorial Hosp. goes the way of S.J. General hosp. with the unpaid bills. "

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wtf wrote on Jul 12, 2008 6:44 AM:

" This is what happens when you have bean counters providing medical care. HMOs are BS...have been from the git go. Get rid of the middle man i.e., insurance companies and go back to the old-fashioned "fee for service" - sure docs would have to do their own billing; but they'd be able to keep the fruits of their labors as well. Ron Paul, a medical doctor, has covered this.

http://www.lewrockwell.com/paul/paul345.html "

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