Stanford and Blue Shield of California Can't Agree on Price -- Patients Lose
Original post made by Bob Wenzlau, Crescent Park, on May 12, 2008
"For many years, Blue Shield of California has contracted with Lucile Packard Children's Medical Group, Menlo Park Medical Group and Stanford Health Clinics. However the contracts ... have been terminated."
Our patient-doctor relationship has "ended" because they can't agree on a price. Perhaps it is trivial for them, but this is scary, expensive and tedious to have to deal with these fallouts. What fun it is to talk to an insurer and learn your options.
There is no tone of remorse in the letter from Blue Shield, and no statement from Stanford at all. In classic insurance speak, they inform us in a letter dated May 7th, that the insurance ended April 26th -- a lucky patient that uses the services after the insurance ends.
The recourse is disappointing. We are advised that we can use the "out of network rate". When one looks at out of network rates, the medical center can gouge the patient that is not paying through an insurance carrier. I have observed that Stanford might bill $1,000 for a procedure, only to accept $200 from the insurer. I anticipate the true fee is somewhere between, but as a patient out of network we are obliged to pay whatever the clinics desire.
Oh....if I could wave my magic wand... I would ask that the insurers and Stanford remember their "falling out" has people in the mix. I would ask them to remember that these falling outs damage patient doctor relationships. I would ask them to remember that consumers of medicine have fewer choices, and that they should strive to find the middle ground.
I share this because Palo Alto is bending over backwards as a community to allow Stanford's expansion of medical services. Their failure to see some duty to the community when they "buck" a deal with a major insurer is unfortunate. The free market certainly is not looking out for us. The patients, and perhaps the community are the losers here.