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BCBS of Massachusetts charges higher fees for expensive hospitals

In an attempt to reduce healthcare costs, Blue Cross Blue Shield of Massachusetts introduced a new plan last month that charges members hefty fees for seeking care at more expensive hospitals--and it has become the insurer's fastest new product launch ever.

The Blue Cross Hospital Choice plan charges members, for example, an extra $1,000 for an inpatient stay or outpatient surgery, and $450 more for an MRI at 15 higher-cost hospitals, including Massachusetts General and Brigham and Women's hospitals. Companies and workers that sign up get a significant break on their health insurance premiums, increasing by 4.5 percent for the first quarter of the year instead of 10 percent, the Boston Globe reports.

Other Massachusetts insurers also report brisk business in plans that offer lower premiums in exchange for limits on use of high-cost care. These plans either charge consumers extra for receiving care from popular but expensive hospitals or doctors, or bar them altogether from seeking treatment at those institutions and practices.

In a similar move, HealthPartners last year started marketing plans that feature a network of hospitals and doctors without the world-renowned Mayo Clinic. HealthPartners' members pay lower premiums when they select a plan with Mayo as an out-of-network option, according to the Pioneer Press.

"When we looked at Mayo's total cost of care--the combination of price and utilization--they, on average, have a higher total cost of care than other health systems that are seeing comparable groups of patients," HealthPartners Chief Marketing Officer Andrea Walsh told the Pioneer Press. "Sometimes, you need to pay more to get high quality, but oftentimes in healthcare, you don't." She estimated that about 25,000 HealthPartners members are in plans with the Mayo Clinic as out of network.

Of course, these plans have their detractors. Executives at Partners HealthCare, the parent organization of Massachusetts General and Brigham and Women's, said that while these new policies are making providers more sensitive to price, they have pitfalls. Dr. Thomas Lee, head of Partners' physician group, said some people will become seriously ill and realize they can't go to, or can't afford, their first-choice hospital. "They will be mad at Blue Cross and their employer," he told the Globe.

Lee also cautioned that hospitals may no longer be able to use their profit margins to subsidize money-losing services such as rehabilitation and children's mental healthcare, which might lead to fewer services offered.

To learn more:
- read the Boston Globe article
- read the Pioneer Press story

Related Articles:
Horizon urges members to avoid hospital due to high fees
Aetna, AMA fight over out-of-network payments
National database will show consumers their out-of-network costs

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