Hopkins could leave the CareFirst network, leaving patients in the lurch

Hopkins could leave the CareFirst network, leaving patients in the lurch

Johns Hopkins has warned nearly 300,000 patients that their doctors, nurses and other healthcare providers may no longer accept CareFirst BlueCross BlueShield health insurance as of December 5, jeopardizing patients’ access to care.

Hopkins and CareFirst are at an impasse over the rates the insurance company pays for care at Hopkins, a major provider of primary, specialty and outpatient surgical services in the region.

CareFirst officials have accused Hopkins of putting “the people we collectively serve” in the middle of contract negotiations that began in June, an allegation denied by Kevin W. Sowers, president of Johns Hopkins Health System and executive vice president of Johns. Hopkins Medicine.

“It was a very difficult decision and was not a mechanism to put patients in the middle,” Sowers said. “We did not take this decision lightly.”

The health system is contractually required to give 90 days notice before providers leave the network, he said. Weekly talks continue over the contract, which covers about 4,000 providers employed by Hopkins at flagship Johns Hopkins Hospital and Bayview Medical Center in Baltimore, as well as Howard County General Hospital in Columbia, N.D. Maryland, Bethesda Suburban Hospital and Sibley Memorial Hospital in Washington. Providers at free-standing ambulatory surgery centers, including those at Bethesda and Columbia, would also be affected.

In addition to providers, Hopkins Hospitals in Maryland could also exit the network, if Hopkins and CareFirst still fail to reach an agreement by March 5, which means hospital stays would not be covered.

The changes would leave people like Deborah Wassertzug, a three-time cancer survivor who requires close monitoring by a team of experts, rushing for a new insurance plan on short notice. As a freelance translator, she is registered with CareFirst through the Affordable Care Act.

“Having a specialist that I can see who’s seen a lot of patients like me is really important, so it’s not like I can go find another doctor,” she said.

Wassertzug, 50, was diagnosed with melanoma in 2013 which later metastasized to his lungs and brain. She is in remission, but a cancer drug she was taking triggered recurrent inflammation of her retina and iris – complications that hampered her vision and required the attention of a Hopkins eye immunologist. This is in addition to a gastroenterologist, a rheumatologist and an oncologist.

His oncologist, who works once a week in Sibley not far from Wassertzug’s home in Rockville, specializes in melanoma, which requires scans as often as every four months and a special type of blood test that acts as a diagnostic system. early warning for cancer. recurrence.

“I think [for] anyone who has had cancer or is dealing with cancer, probably the worst thing they can hear is that there will be a disruption in their access to care or monitoring appointments,” she said. . “You want things to stay on a normal path. It can be quite unsettling to have to change that.

Sowers, the head of Hopkins, said the health system terminated its contract with CareFirst because the rates the insurance company reimburses Hopkins for provider services are 40% lower than other large companies. , such as Cigna and Aetna – a disparity he called unsustainable.

“We felt we had reached a point where we were so far apart that we really had to give them that notice,” he said.

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The dispute comes just before the time when many patients are choosing their health insurance for the coming year, adding to the pressure for CareFirst. Hopkins and CareFirst receive calls from concerned patients, and in addition to letters and emails, Hopkins produced a video featuring Sowers.

Hopkins and CareFirst officials said care could continue, even if no agreement is reached, for some people with serious illnesses, rare disorders or certain cancers, or for those who are enrolled in clinical trials.

“CareFirst has made a strong case for Johns Hopkins’ price increases to be reasonable in this negotiation, as any additional costs will increase the burden on employers and households who already feel strained in this uncertain economy,” officials said. in a press release.

Steven Sacks, 72, a retired longtime Department of Energy employee enrolled in CareFirst in addition to Medicare, speculated that by terminating the contract pending final talks, Hopkins was pressuring CareFirst for him to act.

“They want to see who’s going to blink first,” he said.

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