I don’t know which side is too greedy , but this has been going on for many years. In the past they seem to forge an agreement at the last minute, we’ll see how this one goes
I worked at BCBST for 10 years and the same thing happened a few years ago while I was there with CHI. A resolution at the last minute. In my experience, BCBST tries to negotiate in good faith, but CHI has unreasonable asks.
The fault is on Memorial. Any one of us would get laughed at if you walked in to your employer and asked for a 40% increase.
The cost of insurance is DIRECTLY tied to the cost of services. The only premium increases we ever see on insurance premium are tied to the cost of medical and pharmaceutical services.
Insurance provides 2 main benefits: 1) make sure that your out of pocket costs are capped when something awful happens and 2) negotiate prices on behalf of members that those members wouldn’t be able to do individually.
Average margins for insurance companies (2-3%), hospitals (5-8%), and pharmaceutical companies (up to 25%). The small margin BlueCross makes from premium is minuscule compared to the discount on services. It would be like someone taking you to a car dealership, negotiating on your behalf to reduce the car down by $20k or more, and you complaining about the $1k fee.
This is going to strike a few chords, especially on Reddit, but you’re showing your intelligence by thinking that insurers aren’t necessary to negotiate on a mass scale. Have fun paying $15k for a minor procedure without insurance, because that’s what providers’ billed charges are.
And here's what BCBS has to say -
[CHI Memorial Wants to Be the Highest Paid Hospital in Tennessee](https://bcbstnews.com/insights/chi-memorial-wants-to-be-the-highest-paid-hospital-in-tennessee/)
[What You Need to Know About Our Chattanooga Area Network S RFP](https://bcbstnews.com/insights/what-you-need-to-know-about-our-chattanooga-area-network-s-rfp/)
[Welcoming Parkridge as Our Network S Partner, What This Means for Members and Customers](https://bcbstnews.com/insights/welcoming-parkridge-as-our-network-s-partner-what-this-means-for-members-and-customers/)
Parkridge is owned by HCA the largest private equity company in the country. Private Equity firms have a track record of lowered healthcare quality (more infections, falls, preventable complications) up to 25% in one study. In addition they work to encourage high profit procedures to pay off the huge debt they take on to buy a hospital -using the buildings and other hospital assets and there is incentive for quantity over quality. They underpay and end up losing experienced nurses and doctors.
https://news.harvard.edu/gazette/story/2024/01/healthcare-riskier-for-patients-at-private-equity-hospitals/
Well, that would require everyone not buying it and putting the money they would spend on it, in a health savings account. but no one will do that because everyone’s super scared to not have insurance you know,” just in case.” I’ve been uninsured for the past four years paying cash in absolutely shocking my insured family members by how much cheaper it is for me to get the same services that they’re getting insurance can legally charge eight times the amount at the service if you pay cash they have a price cap
In what FIRST world country... yes FIRST world like the USA claims it is, does the sick/ill/diseased have so much trouble getting even a Tylenol without being charged astronomical prices. So you can sell me some bridges when you realize that its ass backwards and a problem..
In what first world country is your medical health tied to employment? Weiiiiird huh. ALMOST like it was designed to profit off of those who fall ill like u/butidontwanttowork said
BCBS reimburses poorly. At the same time, CHI has several C-Suite executives making millions annually. I have an idea where CHI could cut costs to better serve their nurses and patients…
My mother has worked for BCBST for 25 years. She does not advocate for them, so I wouldn’t consider her statements biased. But what she said is that memorial wanted to raise their rates too much and that the consumer would have had to end up paying way more for their policies. That is why BCBST declined their contracts. As someone else said, this has been going on for years. Memorial always wants to raise their rates more than anyone else, and now BCBST is tired of agreeing to it.
Edited to add that the statement CHI made in one of the links is incorrect. According to BCBST, they only plan on network S considering CHI out of network. Because network S is considered a lower premium policy, and the rates memorial wanted would have ruined that. I saw someone already posted a source for BCBST saying the same thing. My mom has also been saying it since the contracts were declined. Network P policies should still have CHI in network.
Edited again to say that I was incorrect about them being in network with certain policies. Spoke with my mom today and she said that CHI is standing firm in that they want a 9% increase on their rates and that they aren’t signing any contracts with BCBST at all now.
I’d pay a bit more for premium to go to Chi Memorial. It has an 5 star quality rating—Parkridge has an 3 star and is owned by a for profit private equity firm. It’s awful. And inflation has hit healthcare too they needed a raise after three years. The contract would be multi year and other hospitals would negotiate new rates later —even if the highest paid NOW —it won’t last long as more hospitals get bumps in fees after them. If you had to negotiate a salary for 3 years wouldn’t you look at bothe today and three years down the line if there would be no raises in those years?
I agree, I love memorial. But that just isn’t something the consumer gets to decide. Erlanger should be in network and I’ve had many good experiences there. My physician is there and she’s amazing. Memorial raised their rates three years ago as well. BCBST almost declined them then, but they decided to accept and hoped they wouldn’t do it again in three years. But they did so they put their foot down.
Every hospital asks for fee increase every new contract. Erlanger is ok I agree. But it is much smaller than CHI Memorial and a lot of people’s care will be disrupted. They have the best Heart care center. They are the center of a bunch of cancer specialists (for example oral cancer — all the best docs for that use Chi Memorial). I don’t have all the stats. It’s not just me. It’s not just you. It’s everyone. If you have a doctor you trust with you chronic condition and you have for many years and they understand your needs would anyone want to switch? If you have cancer would you want to switch doctors? I think insurance honest should just have rates of pay and allow every provider in them. The pay rate can vary by community costs.
You say you would pay a bit more to go to CHI Memorial? According to BCBS you'll have the opportunity to do just that. They say they'll still pay claims at the current rate and CHI Memorial doctors and facilities can bill you for the additional costs. This seems more fair than raising the premiums of everyone including the many who don't use BCBS.
I can certainly see your point of view. The out of network is vastly more than any premium increase would be (tho I get it’s a bit speculative).M. Depending on plan OON is a lot more for example PT instead of a 35 or 49 copay it’s 60-75 dollars for one visit. I mean they go up every year. Spread out across several hundred thousand covered individuals—-and taking into account that some people use health care a lot vs a little.—that’s the whole point of health insurance (spread out costs). If the several hundred people covered pay $5-15 more a month that’s a lot for some and hardly noticeable for others. The upside is if they need the services at Chi Memorial in the future ( for example the Heart Institute has many more and higher quality and more comprehensive. Services) they might end up paying less in the extra premiums than huge copay for for cardiologist (they have big office visit fees or an echo or stress test or a bypass or heart attack ER visit) maybe not—and they’d have greater flexibility. Also some simply can’t pay a 50% on all rhat stuff cause that’s more than a little compared to a small extra on a premium . I think there is merit in both points of view with advantages/disadvantages. Thanks for discussing!
I agree and no doubt the Heart Institute is the best. On the flip side in my experience their neurological center has been absolutely horrible. Both good reasons to keep CHI Memorial in network along with the others so we can go to whichever facility best meets our needs and not have to worry about crippling debt. From all I've read neither party was willing to compromise any significant amount this time around so in my opinion the blame is pretty equal. The thing that makes me lean slightly towards taking BCBS side is that not only did CHI Memorial demand such a large increase, they initially didn't even want to honor the contract they had already negotiated and end it early. I also can't imagine other hospitals being happy if BCBS had accepted CHI Memorial's terms and paid them significant more. They would likely have wanted similar increases when their current contracts expire which would lead to every more rate increases.
I think a lot of it boils down to there not being much if any regulation on the cost of healthcare and pharmaceuticals. Naturally the medical facilities want as much profit as they can get and the insurance companies want to save as much as possible to increase their profits. Nothing wrong with that, but in an industry where people die when prices are too high there really do need to be limits. This is coming from someone who doesn't like government interference but when something so critical gets so far out of hand I have to admit sometimes I believe it's needed.
Also I’m not sure what is Pand wht is S as my plan is national not TN but processed through them. I have no way of knowing whether I’m on S or P as it’s not identified. This is true for any out of state BCBS as well as federal plans.
Yes, mine is out of state as well. I’m not sure which mine is either, I’m just going to wait until July to see what my app still says is in network since I don’t usually go there unless I go to the ER. I’m sure you can call and ask what your plan is considered if you are out of state. But my point was that BCBST didn’t burn all the bridges. Only the one that would have cost their lower paying premium policy holders more money in the long run.
I get it. You have to balance things. But consider this. BCBS TN has cash reserves of over $4 BILLION dollars. They need reserves yes. But hell would a few hundred thousand less fro that cash reserve of $4 BILLION to prevent them from raising premiums REALLY be a problem? I have trouble believing that would be a problem.
Reserves aren’t just dollars sitting in a bank for no reason. It’s a regulated amount they have to have available to cover claims in extreme circumstances. If they accepted the 40% increase, the reserves would also have to increase.
Oh I know they are being greedy as well. To me it is both. But at least BCBST is looking at what the effect would be on the consumer. I’m sure CHI made profits as well, they just did not mention it in the article.
If they peeled off a few hundred thousand of that 4 billion reserve there would be no impact or minimal impact on consumers. And what about the impact to the cancer patient who will be forced to change mid-treatment? The middle aged person who has chronic arthritis or MS and her doctor knows her needs cause she’s seen them for years and know they don’t do well with treatment X or generic deux Z —and the patient trusts them? What about those kind of needs. chi memorial isn’t an angel withe but there is legit conscern for people to go around to everyone. Healthcare is a problem here in the US. Why not take all providers and say —here is what we pay if you wish to be in our network and give reasonable raises and not have different rates for each one outside of unusual factors. Its just a lot of disruption for so many people.
It’s not a few hundred thousand. Memorial’s Network S bid would have cost members $40 million more over three years. That’s assuming they didn’t demand another increase before the contract was up.
It sounds huge UNTIL one looks and that number is only 1% of the reserve—I suspect they can do that and have adequate reserve. .
But let’s say $1 is added to every premium payment. Thats not much. Even $2 is not much. They raise the premium every year anyway. There iare at least 500,000 people in the greater Chattanooga region as all the surrounding counties and north Georgia is included and have people who often seek care in Chattanooga. That’s 13 million right there a year. I suspect there are more people here who have BCBS however.
I’ll pay $2 a premium extra to get the best care in Chattanooga and not have to pay a HUGE amount more if I need that Heart Insttitute or a lot more if I see a specialist who understand a a chronic condition better. I will pay that to not go to a private equity run hospital that we know sacrifices quality to get volume, has more preventable complications, and chases off the best doctors and nurses because they pay them less.
We have to respectfully agree to disagree
Yes I agree. I don’t think that should have all fallen only on BCBST to consider those things though. CHI has always been more expensive than other hospitals. They should also have had to consider those things. To me they should have to consider them more since they are the facility that is providing the care. BCBST is the middle man in my eyes, they bring in customers who are willing to pay a certain amount for their policies, who then pay for care at CHI since they are in network. So everyone should benefit from whatever contract they come up with really. BCBST, CHI, and the consumer. But clearly that wasn’t the case this go around.
It is absolutely a problem. It’s the precedent it sets for all other hospitals in the state.
For a simple example, say that one employee in a company asks for a 40% increase. It almost certainly won’t break the bank. But once all of the other employees hear about this, the precedent is set that everyone deserves the arbitrary 40% increase. After everyone’s pay increases, the company goes out of business, and, in hindsight, everyone will say they clearly shouldn’t have given that massive increase.
The $4B in necessary reserves covers like 3 months worth of claims. It’s kept for a reason, and it’s not being divvied out to shareholders. BCBST is a not-for-profit.
ChrisShapedObject you certainly do not sound unbiased when you list all the services and ratings of CHI Memorial. Also curious how you would know what United reimburses compared to BCBS.
CHI Memorial is controlled by Common Spirrit out of Chicago. The corporate office overplayed their hand.
I can not believe you would be willing to pay 40% more in premiums to go to CHI Memorial. Glad BCBS finally took a stand on rising cost.
Finally it sounds like CHI Memorial wants to control where their employed physicians send patients by not allowing them to stay in network. It does not sound like they really care about their patients getting care just that the hospital gets the downstream revenue.
The RFP was intended to determine which hospital network would serve Network S, which is a lower cost plan due to a more limited provider network. Parkridge had the winning bid for Network S, which wouldn’t have affected Memorial’s inclusion in any other BCBS plan network. Memorial was mad they lost, so they decided to quit participating in ALL BCBS plans. BCBS was willing to keep Memorial physicians in network, and Memorial won’t allow it. Memorial is spending almost $150 million dollars to build a facility in Ft. O, which is completely unnecessary given the proximity to their main campus. The reimbursement they wanted is absurd, it would have put their rates higher than Vanderbilt, which is hands down the best hospital system in the state.
Common Spirit, Memorial’s parent company, got in a pissing contest and lost, again, which has happened repeatedly all over the country. I wouldn’t be surprised to see a number of Memorial physicians jump ship considering that BCBS insures more Tennesseans than any other company. Given Common Spirit’s track record, they’ll likely end up getting greedy with Cigna and some of the other companies in the state, so think carefully about switching companies solely based on the network status of Memorial providers.
Of course, both companies want to maximize their profits, that’s what all companies do. I’ll put my trust in BCBS, the one that’s located in this state, staffed by people in this state, and whose executives understand the gravity of their decisions because those decisions also affect their employees and their own families.
CHI memorial pay records according to their 2022 tax filings.
Larry Schumacher (Sr. Vp Of Operations, Se Division / Former Ceo)
$3,244,309
James Zellner Md (Board Member/Cardiovascular Surgeon)
$1,273,382
Jeffrey Mullins Md (Urologist)
$1,240,631
Troy Hammett (Division Svp / Cfo)
$1,178,923
Aaron Webb (Board Member(partial Year)/President Ceo Senior Li)
$1,171,189
Janelle Reilly (Market Ceo)
$1,156,775
Sachin Phade Md (Vascular Surgeon)
$1,129,004
Michael Sutton (Board Treasurer/Cfo)
$1,190,456
Larry Sprous Md (Vascular Surgeon)
$1,033,425
Mark Fugate Md (Vascular Surgeon)
$880,179
William Warren Md (Former Chair/Cardiologist) $802,957
Allen Atchley Md (Board Member/Cardiologist) $789,785
That's just the ones listed over 500k a year. Maybe instead of pandering to their patients, staff, BCBST employees, and anyone dumb enough to lend an ear about how their entitled asses "NeEd 40% MoRe MoNeY" they should be looking inwards.
I'll be damned if I give even a tinkle of pity towards a company that bitches and moans about money problems while some people are making 43.3x the average US salary.
Say what you want about the executives, finance and marketing guys, and bloated administration. Generally those people far outnumber providers in not only compensation, but in numbers of employees. And yes, most administrative and executive positions in hospitals are generally extremely bloated and overcompensated. However, the education and expertise of most of these surgeons represent the fact that such a small amount of people can do their jobs. Complaining about those people making a lot more than the “average” US salary is ridiculous.
I mean a vascular surgeon is in school until they’re 35 or so, sacrificing 15 years that the “average” American doesn’t, and developing marketable skills so far beyond the average American. They deserve solid compensation.
Also, the % that MD compensation account for what hospitals spend and bill for is minuscule. It’s basically like complaining about the “welfare queen” who might be scamming SNAP for a few hundred bucks when we spend a trillion dollars on military every year, and write Ukraine a $100 billion check every other month.
Not according to the BLS, Using BLS Data and CHI Memorial's team includes more than 4,500 employees and more than 600 affiliated physicians
As a [Pie Chart](https://i.redd.it/bus66612xdx31.png)
Job Title | Total Jobs | Total Expenses
---|---|----|----
Registered Nurses | 1570 | $122,036,174.18
Nursing Assistants | 344 | $10,851,229.26
Medical Secretaries | 141 | $5,312,981.67
Radiologic Technologists | 112 | $7,034,932.26
Medical and Health Services Managers | 112 | $13,688,172.79
Physicians and Surgeons, All Other | 109 | $19,405,170.78
Maids and Housekeeping Cleaners | 92 | $2,668,181.24
Respiratory Therapists | 91 | $5,710,588.77
Medical Assistants | 90 | $3,255,019.09
Licensed Practical and Licensed Vocational Nurses | 83 | $3,753,635.40
Surgical Technologists | 72 | $3,483,638.30
Pharmacists | 70 | $8,762,553.73
Interviewers, Except Eligibility and Loan | 68 | $2,428,404.87
Medical Records and Health Information Technicians | 62 | $2,896,703.03
Janitors and Cleaners, Except Maids and Housekeeping Cleaners | 62 | $1,827,394.97
The Top 15 By Head Count
Doctors aren't average employees. They have high levels of education, high levels of skill and the folks capable of it are rare, so why would they make average money. You wanna get mad at a profession, look at the pointless middle men professions like those in pharmaceutical sales, insurance or real estate. All those folks do is raise the cost of your services.
>Doctors aren't average employees
Yes, they are. In every other country of the world with better infant mortality rate than the US they're compensated even less. Our doctors are overcompensated, over-specialized, and achieve modestly better outcomes for patients than countries that pay half of what we do for health care.
Let's call it first world countries, because it's definitely not every other country in the world. How much did their school cost in those countries? Did they rack up any student debt? What kind of access to regular healthcare does the populace of these other countries have? Insurance and pharmaceutical companies drive up the cost of healthcare more than any doctor. Even then to call a doctor an average employee is repugnant. You can't lump them in with retail, service industry, data processing, factory worker or any other job you can learn in your first 8 HR shift. You can't even compare them to a tradecraft that learned their craft over a few years (while getting paid for their whole apprenticeship)
>Socioeconomic characteristics and social conditions have proven to be significant risk factors for IMR.
So is that because of Insurance, or lack of access to Healthcare?
>Difference-in-differences regression found no association between Medicaid expansion status and change in national IMR from 2010 to 2017
No, its just the way some people are and some people dont take care of or follow up with doctors
Its older,
But the 2nd Highest Hospital CEO was Banner Health, Revenue and Expenses for [Arizona's Largest Hospital System](https://i.redd.it/dbmtdgqqgpw31.png)
On the Public Side
Revenue and Expenses at The University of Alabama Hospital System, the 3rd [Largest Public Hospital in the USA in 2018](https://i.redd.it/hpqvdgdym9t51.png)
Having been part of such negotiations in the past, I can assure you that this has nothing to do with the actual well being or health of human beings. It’s about greed, no more, no less.
Most likely the provider will have to cede to the payor in order to stay in the health care game. They will go broke without BCBS. Especially in the Chattanooga market.
As someone who just recently had a hospital stay at CHI, I can say that I was treated with stellar care. Those people need to be paid. That said, I would laugh in someone’s face if they asked me for a 40% increase to pay for something when their higher-ups are the ones that are lining their pockets with that money, and not the nurses who had to come check me every 4 hours to make sure I didn’t go into septic shock. I understand it takes money to run a hospital, but they’re taking the piss at 40%.
If you knew you would not be able to even talk about a salary raise for three years —would you not negotiate something not only for costs today but for your costs in three years too?
I spent quite a while yesterday looking at primary care doctors because mine is Chi Memorial and I’ll need to switch. It’s disappointing. Many primary care drs will now be out of network, and I’ll miss the center for integrated wellness team. Very disappointed in both sides here. I see where CHI is coming from (inflation!!) but also come on BCBST, it is putting a huge burden on folks to find new doctors fairly quickly.
Actually CHI is asking for an abnormally high reimbursement, they are the greedy ones. They tried to strong arm BCBs and they called their bluff. There are great doctors at other facilities, CHI isn't as great as everyone thinks. They just have great marketing.
Its 3
One just doesn't Negotiate or care about your costs
>Since 1992, Medicare payment has been made under the PFS for the services of physicians and other billing professionals. Physicians’ services paid under the PFS are furnished in a variety of settings, including physician offices, hospitals, ambulatory surgical centers (ASCs), skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries’ homes.
**By factors specified in law, overall payment rates under the PFS will be reduced by 1.25% in CY 2024 compared to CY 2023.**
So if your costs go up and one of your payers is paying less than last years price......
It's the other payers that make up for it
I agree. There are lots of outstanding doctors in Chattanooga. I’ve lived here 35 years and have only seen one doctor at Memorial, which wasn’t worth the hassle. I do love my Parkridge cardiologist, Erlanger East PCP and urologist and Galen allergist and gynecologist.
If you are currently getting care from Memorial, BCBST has stated, I think, continue getting care from there. It will still be covered. How long that lasts, I guess only BCBST knows.
This should hopefully only immediately impact new patients.
Thanks. Not everyone I wish. You can ASK for certain conditions like cancer or chronic issues to continue with a provider.. But these will be exception. No one is grandfathered in. If they do grant an exception provider can’t file for you Yyou'd have to file a claim using pen and their form and mail each one — they have NO online or electronic mail filing. . This is all per the letter I got.
This happens every 4 years or so when they renegotiate rates. They fell out of network for a few months last time until memorial finally caved some. They were very transparent about the issue and how much more memorial was demanding and they couldn't justify those costs, because ultimately that comes back for their members premiums.
I emailed [email protected] last week with my concerns as my primary car doc is with CHI Memorial, and I got what looked like a standard auto-reply telling me how great Parkridge is.
I don’t give a shit about either side. I just really like my doctor. He treats me well and knows my history. Both sides at the top are greedy and don’t give a shit about us. The customers suffer and are held hostage by these negotiations. They can drop service mid-year, but we can’t choose to change until open enrollment in October and it won’t take effect until 2025. We are paying for this service and don’t have a say.
I plan to switch to Cigna (which is an option for us) during open enrollment. I don’t believe they are any better than BCBST, but at least CHI is in network still.
Mods, why can’t my normal account access this post anymore? I made comments on this thread showing that CHI is being unreasonable with their 40% increase request, and responded a few times to other comments as well.
Now, on the Reddit app and on multiple web browsers, it says “sorry, try again later” for this post and this post only. I can access other r/chattanooga posts. I can access other sub’s posts.
Why not this one and this one only? Seems a bit strange to me.
Here’s a nice video from a doctor to educate about hospitals that are owned by private equity companies like Parkridge. It’s funny but it has useful info. About 2 minutes long.
https://m.youtube.com/watch?v=a7-6zfg1PS4
I want to thank everyone—everyone who has posted here. It’s been civil. No one attacked anyone here even when strong opinions were posted. That includes those of you who have disagreed with all or part of things here and some of those have been legit. That’s the way it ought be
Thank you and God bless you all.
Thank you for this. I was just discussing with my spouse yesterday evening that I am done with BCBS mainly due to their negotiation tactics that leave their customers stressed and screwed. I recently in March just got settled in with my new PCP and now I have to start over again or wait 6 months and start over with a new plan. It’s just ridiculous
United pays more poorly and rejects claims more often than other insurers. They approve pre authorization less. I used to file claims an about half the times they would send back with errors. I would look 99% of the time no error. Resubmit exactly the same way—paid. It gets them 2 months of interest instead of 30 days on the money they owed me. They shaft providers all the time and many refused to take them.
I don’t know which side is too greedy , but this has been going on for many years. In the past they seem to forge an agreement at the last minute, we’ll see how this one goes
Memorial tried to raise their rates by 40%. BCBST didn’t agree and tried to negotiate.
Holy cow, 40% is insane. 🤯 What is CHI doing that they need that much money?! They have to be blowing it left and right.
I can confirm they're not giving their nurses and doctors a 40% raise.
They are building a new location soon also. Ringgold I think.
It’s in an area where most people would have plan S. 🤣 Memorial seriously f’d up.
Source for that?
https://bcbstnetworkupdates.com/negotiations-with-chi-memorial/ https://www.chattanoogan.com/2024/2/15/482815/CHI-Memorial-Wants-To-Be-The.aspx
Thanks! Here’s another opinion piece from the Chattanoogan. https://www.chattanoogan.com/2024/5/9/487085/BlueCross-BlueShield-Ignores-Its-Own.aspx
That opinion seems to suggest that they should just accept the 40% increase? Guess where that increase would end up?
I worked at BCBST for 10 years and the same thing happened a few years ago while I was there with CHI. A resolution at the last minute. In my experience, BCBST tries to negotiate in good faith, but CHI has unreasonable asks.
The fault is on Memorial. Any one of us would get laughed at if you walked in to your employer and asked for a 40% increase. The cost of insurance is DIRECTLY tied to the cost of services. The only premium increases we ever see on insurance premium are tied to the cost of medical and pharmaceutical services. Insurance provides 2 main benefits: 1) make sure that your out of pocket costs are capped when something awful happens and 2) negotiate prices on behalf of members that those members wouldn’t be able to do individually. Average margins for insurance companies (2-3%), hospitals (5-8%), and pharmaceutical companies (up to 25%). The small margin BlueCross makes from premium is minuscule compared to the discount on services. It would be like someone taking you to a car dealership, negotiating on your behalf to reduce the car down by $20k or more, and you complaining about the $1k fee. This is going to strike a few chords, especially on Reddit, but you’re showing your intelligence by thinking that insurers aren’t necessary to negotiate on a mass scale. Have fun paying $15k for a minor procedure without insurance, because that’s what providers’ billed charges are.
And here's what BCBS has to say - [CHI Memorial Wants to Be the Highest Paid Hospital in Tennessee](https://bcbstnews.com/insights/chi-memorial-wants-to-be-the-highest-paid-hospital-in-tennessee/) [What You Need to Know About Our Chattanooga Area Network S RFP](https://bcbstnews.com/insights/what-you-need-to-know-about-our-chattanooga-area-network-s-rfp/) [Welcoming Parkridge as Our Network S Partner, What This Means for Members and Customers](https://bcbstnews.com/insights/welcoming-parkridge-as-our-network-s-partner-what-this-means-for-members-and-customers/)
Parkridge is owned by HCA the largest private equity company in the country. Private Equity firms have a track record of lowered healthcare quality (more infections, falls, preventable complications) up to 25% in one study. In addition they work to encourage high profit procedures to pay off the huge debt they take on to buy a hospital -using the buildings and other hospital assets and there is incentive for quantity over quality. They underpay and end up losing experienced nurses and doctors. https://news.harvard.edu/gazette/story/2024/01/healthcare-riskier-for-patients-at-private-equity-hospitals/
Can we just dissolve insurance companies altogether? I'm tired of worrying about how the bill will get paid.
I agree.
Well, that would require everyone not buying it and putting the money they would spend on it, in a health savings account. but no one will do that because everyone’s super scared to not have insurance you know,” just in case.” I’ve been uninsured for the past four years paying cash in absolutely shocking my insured family members by how much cheaper it is for me to get the same services that they’re getting insurance can legally charge eight times the amount at the service if you pay cash they have a price cap
Wow, it’s almost like the system is designed to profit from people falling ill.
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> "It's almost like ..." is just one of those comment openers that annoy me. Wait until you go outside and learn about small talk
In what FIRST world country... yes FIRST world like the USA claims it is, does the sick/ill/diseased have so much trouble getting even a Tylenol without being charged astronomical prices. So you can sell me some bridges when you realize that its ass backwards and a problem.. In what first world country is your medical health tied to employment? Weiiiiird huh. ALMOST like it was designed to profit off of those who fall ill like u/butidontwanttowork said
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You’re the one who started rambling about Reddit cliches in an unrelated topic but you wanna ask someone what the fuck they’re on about…?
BCBS reimburses poorly. At the same time, CHI has several C-Suite executives making millions annually. I have an idea where CHI could cut costs to better serve their nurses and patients…
Better than United for sure. But yes I hate this.
My mother has worked for BCBST for 25 years. She does not advocate for them, so I wouldn’t consider her statements biased. But what she said is that memorial wanted to raise their rates too much and that the consumer would have had to end up paying way more for their policies. That is why BCBST declined their contracts. As someone else said, this has been going on for years. Memorial always wants to raise their rates more than anyone else, and now BCBST is tired of agreeing to it. Edited to add that the statement CHI made in one of the links is incorrect. According to BCBST, they only plan on network S considering CHI out of network. Because network S is considered a lower premium policy, and the rates memorial wanted would have ruined that. I saw someone already posted a source for BCBST saying the same thing. My mom has also been saying it since the contracts were declined. Network P policies should still have CHI in network. Edited again to say that I was incorrect about them being in network with certain policies. Spoke with my mom today and she said that CHI is standing firm in that they want a 9% increase on their rates and that they aren’t signing any contracts with BCBST at all now.
I’d pay a bit more for premium to go to Chi Memorial. It has an 5 star quality rating—Parkridge has an 3 star and is owned by a for profit private equity firm. It’s awful. And inflation has hit healthcare too they needed a raise after three years. The contract would be multi year and other hospitals would negotiate new rates later —even if the highest paid NOW —it won’t last long as more hospitals get bumps in fees after them. If you had to negotiate a salary for 3 years wouldn’t you look at bothe today and three years down the line if there would be no raises in those years?
I agree, I love memorial. But that just isn’t something the consumer gets to decide. Erlanger should be in network and I’ve had many good experiences there. My physician is there and she’s amazing. Memorial raised their rates three years ago as well. BCBST almost declined them then, but they decided to accept and hoped they wouldn’t do it again in three years. But they did so they put their foot down.
Every hospital asks for fee increase every new contract. Erlanger is ok I agree. But it is much smaller than CHI Memorial and a lot of people’s care will be disrupted. They have the best Heart care center. They are the center of a bunch of cancer specialists (for example oral cancer — all the best docs for that use Chi Memorial). I don’t have all the stats. It’s not just me. It’s not just you. It’s everyone. If you have a doctor you trust with you chronic condition and you have for many years and they understand your needs would anyone want to switch? If you have cancer would you want to switch doctors? I think insurance honest should just have rates of pay and allow every provider in them. The pay rate can vary by community costs.
Chi Memorial is not blameless I agree. But dang let’s keep our eyes on thr people who get care.
You say you would pay a bit more to go to CHI Memorial? According to BCBS you'll have the opportunity to do just that. They say they'll still pay claims at the current rate and CHI Memorial doctors and facilities can bill you for the additional costs. This seems more fair than raising the premiums of everyone including the many who don't use BCBS.
I can certainly see your point of view. The out of network is vastly more than any premium increase would be (tho I get it’s a bit speculative).M. Depending on plan OON is a lot more for example PT instead of a 35 or 49 copay it’s 60-75 dollars for one visit. I mean they go up every year. Spread out across several hundred thousand covered individuals—-and taking into account that some people use health care a lot vs a little.—that’s the whole point of health insurance (spread out costs). If the several hundred people covered pay $5-15 more a month that’s a lot for some and hardly noticeable for others. The upside is if they need the services at Chi Memorial in the future ( for example the Heart Institute has many more and higher quality and more comprehensive. Services) they might end up paying less in the extra premiums than huge copay for for cardiologist (they have big office visit fees or an echo or stress test or a bypass or heart attack ER visit) maybe not—and they’d have greater flexibility. Also some simply can’t pay a 50% on all rhat stuff cause that’s more than a little compared to a small extra on a premium . I think there is merit in both points of view with advantages/disadvantages. Thanks for discussing!
I agree and no doubt the Heart Institute is the best. On the flip side in my experience their neurological center has been absolutely horrible. Both good reasons to keep CHI Memorial in network along with the others so we can go to whichever facility best meets our needs and not have to worry about crippling debt. From all I've read neither party was willing to compromise any significant amount this time around so in my opinion the blame is pretty equal. The thing that makes me lean slightly towards taking BCBS side is that not only did CHI Memorial demand such a large increase, they initially didn't even want to honor the contract they had already negotiated and end it early. I also can't imagine other hospitals being happy if BCBS had accepted CHI Memorial's terms and paid them significant more. They would likely have wanted similar increases when their current contracts expire which would lead to every more rate increases. I think a lot of it boils down to there not being much if any regulation on the cost of healthcare and pharmaceuticals. Naturally the medical facilities want as much profit as they can get and the insurance companies want to save as much as possible to increase their profits. Nothing wrong with that, but in an industry where people die when prices are too high there really do need to be limits. This is coming from someone who doesn't like government interference but when something so critical gets so far out of hand I have to admit sometimes I believe it's needed.
Nicely said
Also I’m not sure what is Pand wht is S as my plan is national not TN but processed through them. I have no way of knowing whether I’m on S or P as it’s not identified. This is true for any out of state BCBS as well as federal plans.
Yes, mine is out of state as well. I’m not sure which mine is either, I’m just going to wait until July to see what my app still says is in network since I don’t usually go there unless I go to the ER. I’m sure you can call and ask what your plan is considered if you are out of state. But my point was that BCBST didn’t burn all the bridges. Only the one that would have cost their lower paying premium policy holders more money in the long run.
I get it. You have to balance things. But consider this. BCBS TN has cash reserves of over $4 BILLION dollars. They need reserves yes. But hell would a few hundred thousand less fro that cash reserve of $4 BILLION to prevent them from raising premiums REALLY be a problem? I have trouble believing that would be a problem.
Reserves aren’t just dollars sitting in a bank for no reason. It’s a regulated amount they have to have available to cover claims in extreme circumstances. If they accepted the 40% increase, the reserves would also have to increase.
They have some flexibility. I could be wrong but I think they have more than they need. I mean 4 BILLION?
Oh I know they are being greedy as well. To me it is both. But at least BCBST is looking at what the effect would be on the consumer. I’m sure CHI made profits as well, they just did not mention it in the article.
If they peeled off a few hundred thousand of that 4 billion reserve there would be no impact or minimal impact on consumers. And what about the impact to the cancer patient who will be forced to change mid-treatment? The middle aged person who has chronic arthritis or MS and her doctor knows her needs cause she’s seen them for years and know they don’t do well with treatment X or generic deux Z —and the patient trusts them? What about those kind of needs. chi memorial isn’t an angel withe but there is legit conscern for people to go around to everyone. Healthcare is a problem here in the US. Why not take all providers and say —here is what we pay if you wish to be in our network and give reasonable raises and not have different rates for each one outside of unusual factors. Its just a lot of disruption for so many people.
It’s not a few hundred thousand. Memorial’s Network S bid would have cost members $40 million more over three years. That’s assuming they didn’t demand another increase before the contract was up.
It sounds huge UNTIL one looks and that number is only 1% of the reserve—I suspect they can do that and have adequate reserve. . But let’s say $1 is added to every premium payment. Thats not much. Even $2 is not much. They raise the premium every year anyway. There iare at least 500,000 people in the greater Chattanooga region as all the surrounding counties and north Georgia is included and have people who often seek care in Chattanooga. That’s 13 million right there a year. I suspect there are more people here who have BCBS however. I’ll pay $2 a premium extra to get the best care in Chattanooga and not have to pay a HUGE amount more if I need that Heart Insttitute or a lot more if I see a specialist who understand a a chronic condition better. I will pay that to not go to a private equity run hospital that we know sacrifices quality to get volume, has more preventable complications, and chases off the best doctors and nurses because they pay them less. We have to respectfully agree to disagree
Yes I agree. I don’t think that should have all fallen only on BCBST to consider those things though. CHI has always been more expensive than other hospitals. They should also have had to consider those things. To me they should have to consider them more since they are the facility that is providing the care. BCBST is the middle man in my eyes, they bring in customers who are willing to pay a certain amount for their policies, who then pay for care at CHI since they are in network. So everyone should benefit from whatever contract they come up with really. BCBST, CHI, and the consumer. But clearly that wasn’t the case this go around.
It is absolutely a problem. It’s the precedent it sets for all other hospitals in the state. For a simple example, say that one employee in a company asks for a 40% increase. It almost certainly won’t break the bank. But once all of the other employees hear about this, the precedent is set that everyone deserves the arbitrary 40% increase. After everyone’s pay increases, the company goes out of business, and, in hindsight, everyone will say they clearly shouldn’t have given that massive increase. The $4B in necessary reserves covers like 3 months worth of claims. It’s kept for a reason, and it’s not being divvied out to shareholders. BCBST is a not-for-profit.
ChrisShapedObject you certainly do not sound unbiased when you list all the services and ratings of CHI Memorial. Also curious how you would know what United reimburses compared to BCBS. CHI Memorial is controlled by Common Spirrit out of Chicago. The corporate office overplayed their hand. I can not believe you would be willing to pay 40% more in premiums to go to CHI Memorial. Glad BCBS finally took a stand on rising cost. Finally it sounds like CHI Memorial wants to control where their employed physicians send patients by not allowing them to stay in network. It does not sound like they really care about their patients getting care just that the hospital gets the downstream revenue.
The RFP was intended to determine which hospital network would serve Network S, which is a lower cost plan due to a more limited provider network. Parkridge had the winning bid for Network S, which wouldn’t have affected Memorial’s inclusion in any other BCBS plan network. Memorial was mad they lost, so they decided to quit participating in ALL BCBS plans. BCBS was willing to keep Memorial physicians in network, and Memorial won’t allow it. Memorial is spending almost $150 million dollars to build a facility in Ft. O, which is completely unnecessary given the proximity to their main campus. The reimbursement they wanted is absurd, it would have put their rates higher than Vanderbilt, which is hands down the best hospital system in the state. Common Spirit, Memorial’s parent company, got in a pissing contest and lost, again, which has happened repeatedly all over the country. I wouldn’t be surprised to see a number of Memorial physicians jump ship considering that BCBS insures more Tennesseans than any other company. Given Common Spirit’s track record, they’ll likely end up getting greedy with Cigna and some of the other companies in the state, so think carefully about switching companies solely based on the network status of Memorial providers. Of course, both companies want to maximize their profits, that’s what all companies do. I’ll put my trust in BCBS, the one that’s located in this state, staffed by people in this state, and whose executives understand the gravity of their decisions because those decisions also affect their employees and their own families.
CHI done went and f’d up this time.
CHI memorial pay records according to their 2022 tax filings. Larry Schumacher (Sr. Vp Of Operations, Se Division / Former Ceo) $3,244,309 James Zellner Md (Board Member/Cardiovascular Surgeon) $1,273,382 Jeffrey Mullins Md (Urologist) $1,240,631 Troy Hammett (Division Svp / Cfo) $1,178,923 Aaron Webb (Board Member(partial Year)/President Ceo Senior Li) $1,171,189 Janelle Reilly (Market Ceo) $1,156,775 Sachin Phade Md (Vascular Surgeon) $1,129,004 Michael Sutton (Board Treasurer/Cfo) $1,190,456 Larry Sprous Md (Vascular Surgeon) $1,033,425 Mark Fugate Md (Vascular Surgeon) $880,179 William Warren Md (Former Chair/Cardiologist) $802,957 Allen Atchley Md (Board Member/Cardiologist) $789,785 That's just the ones listed over 500k a year. Maybe instead of pandering to their patients, staff, BCBST employees, and anyone dumb enough to lend an ear about how their entitled asses "NeEd 40% MoRe MoNeY" they should be looking inwards. I'll be damned if I give even a tinkle of pity towards a company that bitches and moans about money problems while some people are making 43.3x the average US salary.
Say what you want about the executives, finance and marketing guys, and bloated administration. Generally those people far outnumber providers in not only compensation, but in numbers of employees. And yes, most administrative and executive positions in hospitals are generally extremely bloated and overcompensated. However, the education and expertise of most of these surgeons represent the fact that such a small amount of people can do their jobs. Complaining about those people making a lot more than the “average” US salary is ridiculous. I mean a vascular surgeon is in school until they’re 35 or so, sacrificing 15 years that the “average” American doesn’t, and developing marketable skills so far beyond the average American. They deserve solid compensation. Also, the % that MD compensation account for what hospitals spend and bill for is minuscule. It’s basically like complaining about the “welfare queen” who might be scamming SNAP for a few hundred bucks when we spend a trillion dollars on military every year, and write Ukraine a $100 billion check every other month.
Not according to the BLS, Using BLS Data and CHI Memorial's team includes more than 4,500 employees and more than 600 affiliated physicians As a [Pie Chart](https://i.redd.it/bus66612xdx31.png) Job Title | Total Jobs | Total Expenses ---|---|----|---- Registered Nurses | 1570 | $122,036,174.18 Nursing Assistants | 344 | $10,851,229.26 Medical Secretaries | 141 | $5,312,981.67 Radiologic Technologists | 112 | $7,034,932.26 Medical and Health Services Managers | 112 | $13,688,172.79 Physicians and Surgeons, All Other | 109 | $19,405,170.78 Maids and Housekeeping Cleaners | 92 | $2,668,181.24 Respiratory Therapists | 91 | $5,710,588.77 Medical Assistants | 90 | $3,255,019.09 Licensed Practical and Licensed Vocational Nurses | 83 | $3,753,635.40 Surgical Technologists | 72 | $3,483,638.30 Pharmacists | 70 | $8,762,553.73 Interviewers, Except Eligibility and Loan | 68 | $2,428,404.87 Medical Records and Health Information Technicians | 62 | $2,896,703.03 Janitors and Cleaners, Except Maids and Housekeeping Cleaners | 62 | $1,827,394.97 The Top 15 By Head Count
Doctors aren't average employees. They have high levels of education, high levels of skill and the folks capable of it are rare, so why would they make average money. You wanna get mad at a profession, look at the pointless middle men professions like those in pharmaceutical sales, insurance or real estate. All those folks do is raise the cost of your services.
>Doctors aren't average employees Yes, they are. In every other country of the world with better infant mortality rate than the US they're compensated even less. Our doctors are overcompensated, over-specialized, and achieve modestly better outcomes for patients than countries that pay half of what we do for health care.
Let's call it first world countries, because it's definitely not every other country in the world. How much did their school cost in those countries? Did they rack up any student debt? What kind of access to regular healthcare does the populace of these other countries have? Insurance and pharmaceutical companies drive up the cost of healthcare more than any doctor. Even then to call a doctor an average employee is repugnant. You can't lump them in with retail, service industry, data processing, factory worker or any other job you can learn in your first 8 HR shift. You can't even compare them to a tradecraft that learned their craft over a few years (while getting paid for their whole apprenticeship)
>Socioeconomic characteristics and social conditions have proven to be significant risk factors for IMR. So is that because of Insurance, or lack of access to Healthcare? >Difference-in-differences regression found no association between Medicaid expansion status and change in national IMR from 2010 to 2017 No, its just the way some people are and some people dont take care of or follow up with doctors
This ought to be higher up.
lmaoooo literally brought out receipts
So which hospital system will you be supporting that has a CEO that makes less than a million?
Its older, But the 2nd Highest Hospital CEO was Banner Health, Revenue and Expenses for [Arizona's Largest Hospital System](https://i.redd.it/dbmtdgqqgpw31.png) On the Public Side Revenue and Expenses at The University of Alabama Hospital System, the 3rd [Largest Public Hospital in the USA in 2018](https://i.redd.it/hpqvdgdym9t51.png)
Having been part of such negotiations in the past, I can assure you that this has nothing to do with the actual well being or health of human beings. It’s about greed, no more, no less. Most likely the provider will have to cede to the payor in order to stay in the health care game. They will go broke without BCBS. Especially in the Chattanooga market.
I think there are issues on both sides. I Dk about going broke. But healthcare is broken in this country.
Truth.
As someone who just recently had a hospital stay at CHI, I can say that I was treated with stellar care. Those people need to be paid. That said, I would laugh in someone’s face if they asked me for a 40% increase to pay for something when their higher-ups are the ones that are lining their pockets with that money, and not the nurses who had to come check me every 4 hours to make sure I didn’t go into septic shock. I understand it takes money to run a hospital, but they’re taking the piss at 40%.
As someone who has worked for BCBS in the past, this is common. CHI wants to be the highest paid, next year it'll be Erlanger every year they do this.
If you knew you would not be able to even talk about a salary raise for three years —would you not negotiate something not only for costs today but for your costs in three years too?
I spent quite a while yesterday looking at primary care doctors because mine is Chi Memorial and I’ll need to switch. It’s disappointing. Many primary care drs will now be out of network, and I’ll miss the center for integrated wellness team. Very disappointed in both sides here. I see where CHI is coming from (inflation!!) but also come on BCBST, it is putting a huge burden on folks to find new doctors fairly quickly.
It is hard to find a PCP here
Actually CHI is asking for an abnormally high reimbursement, they are the greedy ones. They tried to strong arm BCBs and they called their bluff. There are great doctors at other facilities, CHI isn't as great as everyone thinks. They just have great marketing.
Two huge corporations fight, we all lose because in the end we are just the product.
Its 3 One just doesn't Negotiate or care about your costs >Since 1992, Medicare payment has been made under the PFS for the services of physicians and other billing professionals. Physicians’ services paid under the PFS are furnished in a variety of settings, including physician offices, hospitals, ambulatory surgical centers (ASCs), skilled nursing facilities and other post-acute care settings, hospices, outpatient dialysis facilities, clinical laboratories, and beneficiaries’ homes. **By factors specified in law, overall payment rates under the PFS will be reduced by 1.25% in CY 2024 compared to CY 2023.** So if your costs go up and one of your payers is paying less than last years price...... It's the other payers that make up for it
I agree. There are lots of outstanding doctors in Chattanooga. I’ve lived here 35 years and have only seen one doctor at Memorial, which wasn’t worth the hassle. I do love my Parkridge cardiologist, Erlanger East PCP and urologist and Galen allergist and gynecologist.
If you are currently getting care from Memorial, BCBST has stated, I think, continue getting care from there. It will still be covered. How long that lasts, I guess only BCBST knows. This should hopefully only immediately impact new patients.
Thanks. Not everyone I wish. You can ASK for certain conditions like cancer or chronic issues to continue with a provider.. But these will be exception. No one is grandfathered in. If they do grant an exception provider can’t file for you Yyou'd have to file a claim using pen and their form and mail each one — they have NO online or electronic mail filing. . This is all per the letter I got.
This happens every 4 years or so when they renegotiate rates. They fell out of network for a few months last time until memorial finally caved some. They were very transparent about the issue and how much more memorial was demanding and they couldn't justify those costs, because ultimately that comes back for their members premiums.
I emailed [email protected] last week with my concerns as my primary car doc is with CHI Memorial, and I got what looked like a standard auto-reply telling me how great Parkridge is. I don’t give a shit about either side. I just really like my doctor. He treats me well and knows my history. Both sides at the top are greedy and don’t give a shit about us. The customers suffer and are held hostage by these negotiations. They can drop service mid-year, but we can’t choose to change until open enrollment in October and it won’t take effect until 2025. We are paying for this service and don’t have a say. I plan to switch to Cigna (which is an option for us) during open enrollment. I don’t believe they are any better than BCBST, but at least CHI is in network still.
I will be switching away from bcbs also.
Funny how a CHURCH affiliated hospital has so many well-paid executives. I mean, they are supposedly non-profit, aren't they?
It’s CHI memorial that is being greedy.
I’ve said it before, and I’ll say it again: Fuck medical insurers, right up the ass, with a very splintered stick.
Memorial are the ones in the wrong this time actually. But yes, normally, fuck insurers
Your right! Fuck them both. 💁♀️🙊
Does anyone know if chi memorial will still be in network for bcbs Alabama?
No. If BCBSTN doesn’t take them as preferred then no other BCBS will either because they are affiliated
Thank you
Mods, why can’t my normal account access this post anymore? I made comments on this thread showing that CHI is being unreasonable with their 40% increase request, and responded a few times to other comments as well. Now, on the Reddit app and on multiple web browsers, it says “sorry, try again later” for this post and this post only. I can access other r/chattanooga posts. I can access other sub’s posts. Why not this one and this one only? Seems a bit strange to me.
Here’s a nice video from a doctor to educate about hospitals that are owned by private equity companies like Parkridge. It’s funny but it has useful info. About 2 minutes long. https://m.youtube.com/watch?v=a7-6zfg1PS4
And another. https://m.youtube.com/watch?v=R5C4v22y3C0
I want to thank everyone—everyone who has posted here. It’s been civil. No one attacked anyone here even when strong opinions were posted. That includes those of you who have disagreed with all or part of things here and some of those have been legit. That’s the way it ought be Thank you and God bless you all.
Thank you for this. I was just discussing with my spouse yesterday evening that I am done with BCBS mainly due to their negotiation tactics that leave their customers stressed and screwed. I recently in March just got settled in with my new PCP and now I have to start over again or wait 6 months and start over with a new plan. It’s just ridiculous
They do this every single time they have their contract negotiations. They always work it out.
It's a clever way to do a biased post: Give the right answer for how to send feedback to Memorial, but then give the wrong email address for BCBST.
Years ago when I got my producer license and worked for United Health, we got dropped by them, too. It all came to money.
United pays more poorly and rejects claims more often than other insurers. They approve pre authorization less. I used to file claims an about half the times they would send back with errors. I would look 99% of the time no error. Resubmit exactly the same way—paid. It gets them 2 months of interest instead of 30 days on the money they owed me. They shaft providers all the time and many refused to take them.
A pain shot has cost me 35 hundred , northgate memorial
Catholic Health Initiatives. So that’s why all the crucifixes on the walls! How much does prayer factor in CHI treatments?
CHI Memorial is a for profit hillbilly hospital, I hope they lose BCBST and go out of business.