Blue Cross Blue Shield difficult to work with, according to survey

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Survey highlights tension between insurer and health care providers

A national survey of hospital leaders has found that the Blue Cross Blue Shield insurance group is considered one of the most difficult to work with. The survey was conducted by ReviveHealth, a research organization that was hired by the Medical College of Georgia Hospital and Clinics (MCG). The survey suggests that the relationship between the insurance group and many of the country’s health care professionals and systems is strained at best. This tension could be causing significant problems, which are most felt by consumers that are trying to get the medical care they need.

Industry dynamics often lead to strife

The relationship shared between insurers and health care groups has long been complicated. The dynamics of the two industries have been known to cause strife at times, especially when prominent groups in these industries begin to cast blame over the prevalence of problems. According to the survey, Blue Cross Blue Shield has been singled out as one of the most problematic insurance groups to work with, from a health care perspective.

Survey suggests trouble lies in disagreement concerning coverage rates

The survey shows that MCG and Blue Cross Blue Shield cannot even agree on the insurance policies that are meant to protect the group. According to MCG, the plan calls for an average rate increase of 13% at regular intervals. Blue Cross Blue Shield claims that the rates are to be raised three times higher than that. MCG notes that such a drastic increase in coverage rates would directly impact the cost of medical care, as the organization would have to work to compensate for potential financial losses.

Blue Cross Blue Shield expressed commitment to resolve issues with care providers

Though the insurer considers the survey to be faulty on some points, Blue Cross Blue Shield has expressed commitment to reaching an agreement with MCG and other health care groups to resolve the situation. It is unclear exactly how the matter will be resolved, but some compromise in regards to insurance rates is expected take place.

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Comments by Blue Cross and Blue Shield of Georgia Representative:

The sample size is relatively small for the Revive study.  Only 258 interviews were conducted with contract negotiators…Most likely not a physician.   On average that would be less than less than 6 surveys per state since they state they covered all 50 states.

(To give this some perspective, our enterprise survey of the providers in our network is much larger.  For our 2011 Customer Viewpoint Program (CVP) Provider Relationship Study, we surveyed 1,556 medical physicians and 2,084 medical office managers in our networks, of which 121 physicians and 162 medical office managers from GA were surveyed.)

Comments about overall BCBSGa/WellPoint’s Service Operations:

Paying claims is a primary service provided by BCBSGa/WellPoint, and one that we take very seriously. We are continually working to improve our service levels, and our customers, provider partners and oversight agencies hold us accountable for how quickly and accurately we process claims. We hold ourselves to that high standard as well.

BCBSGa/WellPoint is committed to making health care more effective and affordable for all Americans. As part of our ongoing work to simplify administrative tasks for physicians, we have developed transparency tools that promote efficiency and enable physicians to spend more time with patients and less time on paperwork.

BCBSGa/WellPoint’s Voice of the Customer Insights BCBSGa/WellPoint invests yearly into conducting surveys of their customer groups (Providers & Members)  to provide insights that champion the “voice of the customer” and focus on customer needs and expectations.

Provider Service Transaction Surveys 2011/2012 Over the years we have consistently received high satisfaction scores from Georgia providers when calling into our provider service centers.  In the most recent quarter of 2012, more than 9 out of 10 Georgia providers were satisfied with the overall service quality.

Over 90% of providers were satisfied with getting a resolution and being presented with solutions on their most recent call to the service centers.

Customer ViewPoint Program (CVP) Member Survey 2011 Members: We are dedicated to the experience our members have with us, and have seen improvement in satisfaction among our members in Georgia over the years.  In 2011, 9 out of 10 members were satisfied with Blue Cross Blue Shield of Georgia’s call centers.

Sources: 2011 Customer ViewPoint Program (CVP) Member Survey 2011 Provider Service Transaction Survey

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