April 06, 2016

UAB employee co-pays unaffected by changes in BCBS tier-based reimbursement

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health insuranceA change in the way Blue Cross/ Blue Shield of Alabama reimburses for hospital care will affect UAB Hospital, but UAB employees are not subject to these out-of-pocket cost increases, university officials say.

BCBS has used a two-tier hospital classification for more than a decade to encourage high-quality, low-cost care, and UAB Hospital always has been a Tier 1 provider. This year the insurer changed its formula so that cost (negotiated reimbursement) now accounts for half the ranking; quality of care and patient experience comprise 30 and 20 percent, respectively. “UAB negotiated a fair reimbursement with BCBS, but under the revised program there is no way for UAB to continue be a Tier 1 hospital,” said UAB Health System CEO Will Ferniany, Ph.D.

UAB employees who selected a Blue Cross/ Blue Shield plan during open enrollment, however, will not be among those with higher co-pays, says UAB’s Chief Human Resources Officer Alesia Jones. The university and similar large, self-insured employers are exempt from distinctions based on the tier ranking, which applies only to individual and small-group plans.

Most important, Jones said, employees should know that this change does not reflect any decrease in the quality of care provided by UAB — the only hospital in Alabama ranked among the nation’s best by U.S. News and World Report — and even BCBS’s new rating reflected the highest possible score for patient satisfaction.

UAB has called for BCBS to retract its rating and exempt UAB Hospital from the tier status — as it did Children’s of Alabama — because of the unique and highly specialized services that only UAB provides for the state’s citizens.

“We work very hard to be the hospital that Alabama needs us to be, the flagship and safety net hospital for the state,” Ferniany said. “Patients who need tertiary comprehensive care available at UAB should not have to pay more.”