Georgia hospital close to closure sues BCBS over reduced payments
- A hospital in northwest Georgia has sued Blue Cross and Blue Shield of Georgia, claiming the insurer paid less than the contractually agreed rates for services, putting the hospital at risk of closure, Becker’s Hospital CFO reported.
- According to court documents, “reimbursement has ranged from essentially nothing at all, and ludicrously low, to other amounts which were consistently far lower than what was required by the formal contract in place.” The complaint is in the U.S. District Court for the Northern District of Georgia.
- Located in Fort Oglethorpe, Ga., hear the Tennessee line, Cornerstone Medical Center is the only hospital serving rural Walker County. It previously went through bankruptcy, resulting in its acquisition by Atlanta-based ApolloMD in 2015.
Hospitals are facing tough times with high expenses and declining admissions, coupled at times with lower reimbursement rates.
Recent closures in New Hampshire and Texas highlight some of those struggles. For example, Walnut Hill Medical Center in Dallas closed up shop earlier this month following a terminated Medicare provider agreement. And Crotched Mountain Specialty Hospital is expected to shutter operations at the end of August due to unsustainable costs.
Rural hospitals are especially at risk and those issues can be exacerbated if and when a payer does not hold up their end of a payment agreement. Since 2010, 79 rural hospitals have closed, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina-Chapel Hill. The National Rural Health Association says at least 600 more are at risk of closing.
More rural hospitals could fail if Congress rolls back Medicare Medicaid funding in in legislation to replace the Affordable Care Act. A recent study showed Medicare and Medicaid patients comprise 63% of rural hospitals’ volume, compared with 49% at urban hospitals.
- Becker's Hospital CFO Georgia hospital says it risks closure due to underpayments by BCBS