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Issue: # 26 January 7, 2009
78 pleasant
Greetings!
 
  
Tufts Medical Center Threatens
 
To Drop Blue Cross
 
 
 
In the Boston Globe yesterday there was a story stating that Tufts Medical Center will drop certain Blue Cross and Blue Shield of Massachusetts HMO /PPO's as accepted health plans after January 31st.  Tufts CEO Ellen Zane told the Globe their doctors & hospital get 20% to 40% less from Blue Cross than other major teaching hospitals, even though Blue Cross ranks Tufts among the top three teaching hospitals in Massachusetts.  A spokesman for Blue Cross Blue Shield of Massachusetts, on the other hand, stated that Tufts' pay-raise demands are out of line with what the company is offering to other hospitals.  If you would like a list of those affected physicians/ providers, click here.

 
This reminds us of when Partners HealthCare, the umbrella over Massachusetts General & Brigham and Women's hospitals, did this in 2000. In a bid to get higher pay from Tufts Health Plan (the insurer), Partners threatened to stop taking Tufts insurance. Tufts ultimately gave into Partners' demands.  In fact the Boston Globe recently had a great story on this last month. 
 
It is highly likely an agreement will eventually be worked out, although Tufts Medical Center may not have the same clout as Partners Healthcare. More importantly, can they afford to turn away Blue Cross HMO/PPO members, the largest provider in the Commonwealth?
 
We have seen the "HMO world" change since their initial popularity over the last 15-20 years.   Originally, the HMO (Health Maintenance Organizations) was not intended to accept every hospital and doctor in the Commonwealth as they do now.   By naming select hospitals & doctors, the HMO goal was to negotiate lower rates by guaranteeing patients & passing the savings on to participating employers. You may see movement back to this original model with multiple networks (like Fallon) by each of the carriers.
  
If you have any questions, email Bill  or Vanessa.  To learn more about Advantage Benefits, click here.  Many of our clients have found these newsletter to be quite helpful and we have now set up a link to hold all of the archived newsletters on-line that can be accessed at anytime.
 
IF you know anyone who may find this information of interest, please forward them this newsletter (there is a link on the bottom), and they can subscribe themselves.
  
P.S.  Don't forget to remind employees the year end 1099-HC will be mailed out by all the Health Carriers this month! Mass. State Tax Returns can not be filed without this info.
 
Happy New Year,
 

Bill Randell, CLU, CHFC             Vanessa Costa, CLU,CHFC
Advantage Benefits Group, Inc.