In Children’s Hospital talks, Blue Cross doctor puts patients firstJuly 5, 2017
As a physician, I have enormous respect for the excellent medical care provided at Children’s Minnesota. For more than 90 years, Children’s has been a critically important member of the broader health care community, both in Minnesota and in the entire upper Midwest region.
As the chief medical officer for Blue Cross and Blue Shield of Minnesota, I also respect Children’s desire to keep their health care services and facilities as strong as possible. Blue Cross has enjoyed a long and productive relationship with Children’s over the years, resulting in countless cases where families found hope, support and access to life-saving treatment.
Unfortunately, this relationship is now under significant pressure.
By now, you are likely aware that the business contract between Children’s and Blue Cross expired at midnight on July 5, 2017. The negotiations surrounding a possible new contract have been well documented over the past few months.
It is not my desire here to offer another perspective on previous financial deliberations or to speculate on where those discussions may go from here. Instead, I want to address the most important consideration that arises in the rare event when a hospital elects to leave our network – the need to make sure that every patient is taken care of and fully understands their choices.
I, along with other clinical leaders from Blue Cross, continue to be in regular conversations with our counterparts at Children’s, actively discussing complex cases that require close coordination regarding transition of care.
We have co-reviewed literally thousands of cases submitted by Children’s, categorizing them by medical need and clarifying roles and responsibilities on how to ensure that every patient has a plan for either ongoing care at Children’s or a safe transition to continued care elsewhere. To date, Blue Cross has approved 100 percent of the more than 4,000 patients submitted by Children’s for continued care at their hospital.
For patients that may need to seek care outside of Children’s, Minnesota is fortunate to have hospitals located throughout the Twin Cities and in Greater Minnesota that provide excellent pediatric services. I have confidence in the clinical abilities of each of them and their capacity to serve Children’s patients.
The following in-network pediatric hospitals have the capacity to enroll new patients:
- Gillette Children’s Specialty Healthcare
- Mayo Clinic Children’s Hospital
- Sanford Children’s Hospital
- Shriners Hospitals for Children
- Fairview Health Systems
I greatly appreciative of the willingness of these hospitals to prepare for the possible arrival of patients from Children’s. However, the clinical teams at Blue Cross and Children’s continue to take our shared responsibility very seriously, co-reviewing each new request to continue care at Children’s.
Blue Cross member service representatives are available to answer your questions about the process for submitting what is called an “out-of-network exception request” for continued care at Children’s. Our dedicated number for Children’s patients and families is 855-579-7657.
While Children’s and Blue Cross may have different perspectives on business matters, we know that people are counting on us to work together and make sure that no one goes without the care that they need.
Glenn Pomerantz is chief medical officer at Blue Cross and Blue Shield of Minnesota.
Editor’s note: Members can find answers to coverage questions on our website or by calling us at 855-579-7657