So, Who Really ‘Runs This State?’

Some say that The University of Georgia Bulldogs  ‘run this state.’ But Georgia Tech Coach Paul Johnson thinks UGA should have “…to take down that dumb ‘We-Run-This-State’ sign for one year,” after the Bulldogs loss to the Yellow Jackets last week.  But really, it’s neither university nor their football programs. Blue Cross Blue Shield runs this state.

For starters, they manage the health insurance services for some 650,000 state employees and their dependents, and have probably a couple of million more non-state employee customers in Georgia. They charge customers premiums, and then negotiate contracts to decide how much of those premiums go to the doctors and hospitals that provide the actual health care. Tiny Cedartown, in Polk County, just switched from BCBS to United Healthcare after “…BCBS planned a rate increase the city just couldn’t stomach.” Now, they’re refusing to negotiate with Grady Hospital over provider reimbursement. But Grady has hit back with an advertising campaign that claims Blue Cross pays Grady up to 70 percent less than what it pays other Georgia hospitals, and that “Blue Cross Blue Shield pushed Grady out of its network.”

From Georgia Health News: “With full-page advertisements in newspapers and through TV commercials, Grady Health System has ramped up its media campaign to bring attention to what it says are unfair payments from Georgia’s largest insurer. ‘Blue Cross Blue Shield pushed Grady out of its network,’ say the ads in the Wall Street Journal and the AJC, which appeared in editions this week.”

That could be a typical negotiation between an insurance company and a hospital that probably happens every year. But it could also be a sign that Blue Cross, with a near monopoly on insurance in Georgia, just doesn’t care about patients at the State’s largest hospital. One can only imagine how little they must think of the smaller hospitals in Georgia.

Why does this matter?  In many parts of rural Georgia, the State is the largest employer. Thus, the number of patients with private insurance served by critical access hospitals who are state employees are a large number of the potential “paying” clientele.  There’s a lot of grousing coming from influential corners of the Capitol that BCBS is cutting reimbursements to providers to the equivalent of Medicaid – i.e., below the cost of services provided.  This is said to be exacerbating the problems already faced by the cash strapped rural health care providers.

It’s long been a talking point that there are “two Georgias”.  Blue Cross Blue Shield may have found a way to unite the two Georgias.  Unfortunately for them, it appears to be against the state’s largest private insurer.

3 comments

  1. saltycracker says:

    Would BCBS raise their rates, still be competitive, pay the hospitals a bit more and the state pass the cost to employees ? Or is BCBS paying the hospitals fairly and getting their customers a good deal ?

    Somebody ain’t gonna be happy. And a lesson to some counties is not get in the healthcare wars for monopoly.

  2. It’s interesting that the state’s largest insurer wants to pay Medicaid-level reimbursement rates in rural areas. We are told many times here that the system can’t function if that happens.

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