Children's and BCBS are in the final days of their fee schedule negotiations, and if they aren't able to come to an agreement, it is predicted that 70,000 kids insured through BCBS will no longer be able to receive care in-network at Children's. Including Sully. Who needs a third surgery that I would very much like done by the same doctor who did his first two procedures (bummer note: we found out yesterday that his tubes have come out and he has a double ear infection). So I am upset. But ultimately, this isn't about us.
Blue Cross Blue Shield has demanded that Children's accept a 31% cut to rates they receive for kids insured through Medicaid as part of a strategy to cover losses incurred in the individual market and PMAP population. Children's argues this isn't sustainable, and that it will affect their ability to provide high quality care to kids (last year they had over half a million patient visits). Fee schedules... reimbursement rates... contracts... blah blah blah.
I don't like it when big kids can't play nice and it affects little kids. I especially don't like it when Children's gives BCBS a list of 6,000 patients they have identified as having complex care needs that can't be adequately met anywhere other than at their hospital without having to put the family through extreme hardship, and BCBS drags their feet on deciding if they will let those families remain in network. Sure, sometimes negotiating means playing chicken. And sometimes the consequence of that is that parents of really sick kids are currently suffering as they wonder what the hell they are going to do for healthcare for their babies after Wednesday. I swear to god, this stuff makes me so mad I could hit someone. And I am rarely moved to violence. So. What to do?
Children's provided parents with an email template to automatically send to the BCBSMN CEO after adding a signature, this was the email:
"Dear Mr. Guyette,
Children’s Minnesota is vital to the healthcare of kids in Minnesota. I believe that Blue Cross and Blue Shield of Minnesota is being unreasonable with its demands, and should change its position to make sure a deal is reached.
I’m asking that you put children first, so kids in Minnesota can maintain their in-network access to care at Children’s.
Sincerely,
XXXX "
A great email. And of course he isn't reading them, the point is just to inundate his inbox. But I decided to send my own email:
"Dear Mr. Guyette,
When he was 12 months old, my son stopped breathing in my
arms. Luckily I was at Children’s
Hospital-St. Paul emergency department, and they saved his life. See, I didn’t know what anaphylaxis in a 1
year old looked like, but the nurse working at the front desk did. We didn’t even sit down before she started
walking us back to a procedure room, and when he lost consciousness and his
lips turned blue and I yelled to her, “He isn’t breathing!”, she didn’t break
her stride as she put a hand on my arm and said, evenly, “I know he isn’t”. She led us into a suite full of physicians,
nurses, and respiratory therapists who immediately, effectively, expertly, did
everything he needed to survive.
Sullivan has also had two surgeries at Children’s with
the same physician since September of last year, and we found out on July 1st
that he will need yet another one. If your negotiations fail, we will ultimately
need to have the 3rd procedure done at a different hospital, with a new care
team, and that is stressful and scary as a parent. I know
that the alternatives BCBS is recommending are good hospitals, and that my
child will receive good care. But I don’t
have a relationship with them. I don’t
trust them in the same way. I haven’t
watched them as they saved my baby’s life.
I share these stories about Sullivan because healthcare for
children should not be transactional and hearing the illness narratives of
families should remind you of that. But
I am not appealing on behalf of my family.
I am writing on behalf of the 6,000 kids that Children’s has identified
as needing to stay in-network to not experience a catastrophic disruption in
their care. I’m appealing on behalf of
the families who Blue Cross has referred to Milwaukee and Sioux Falls (in the
absence of access to Children’s). My
family lived in Albuquerque for three years and my son needed specialty care
that could not be provided in New Mexico.
We have lived through the nightmare of having to leave the state to get
healthcare for our child. Having a sick
child is a traumatic experience. Having to leave home to care for your child
only compounds that trauma.
If negotiations fail for the other 60,000+ plus kids,
including my child, I hope that you will do everything you can to make sure those
6,000 families stay in-network.
Regardless of their PMAP status.
Regardless of your bottom line.
Sincerely,
Blair Olson"
We will see what they decide on July 5th.
