If John Hopkins shuts down CareFirst, patient access to care is at risk

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Johns Hopkins has warned nearly 300,000 patients that their doctors, nurses and other healthcare providers may stop accepting CareFirst BlueCross BlueShield health insurance starting December 5, jeopardizing patients’ access to care.

Hopkins and CareFirst are in an impasse over the rates the insurance company pays for care at Hopkins, a large provider of primary, specialty and outpatient surgical services in the area.

CareFirst officials accused Hopkins of putting “the people we collectively serve” at the center of contract negotiations that began in June, a claim backed by Kevin W. Sowers, president of the Johns Hopkins Health System and executive vice president of Johns Hopkins Medicine, rejected.

“This was a very difficult decision and not a mechanism to put patients first,” Sowers said. “We didn’t take this decision lightly.”

The healthcare system is contractually required to give 90 days’ notice before providers leave the network, he said. Weekly discussions continue about the contract, which includes approximately 4,000 Hopkins-employed providers at Johns Hopkins flagship hospital and Bayview Medical Center in Baltimore, Howard County General Hospital in Columbia, Maryland, Suburban Hospital in Bethesda and Sibley Memorial Hospital Washington. provider at independent outpatient surgery centersincluding those in Bethesda and Columbia, would also be affected.

In addition to providers, Hopkins hospitals in Maryland may also exit the network if Hopkins and CareFirst still cannot reach an agreement by March 5, meaning hospitalizations would not be covered.

The changes would mean people like Deborah Wassertzug, a three-time cancer survivor who needs close monitoring by a team of experts, having to seek a new insurance plan at short notice. As a freelance translator, she is registered with CareFirst through the Affordable Care Act.

“It’s really important to have a specialist that I can see who has treated a lot of patients like me, so it’s not like I can switch to another doctor,” she said.

In 2013, 50-year-old Wassertzug was diagnosed with melanoma, which later metastasized to the lungs and brain. She’s in remission, but a cancer drug she was taking was triggering recurrent inflammation of her retina and iris — complications that affected her vision and required treatment by a Hopkins eye immunologist. There is also a gastroenterologist, a rheumatologist and an oncologist.

Her oncologist, who has weekly sessions at Sibley not far from Wassertzug’s Rockville home, specializes in melanoma, which requires scanning every four months, and a special type of blood test that acts as an early warning system for cancer recurrence.

“I find [for] Anyone who has had or is dealing with cancer is probably the worst thing they can hear about their access to care or monitoring appointments being cut off,” she said. “They want things to stay normal. It can be quite unsettling to have to change that.”

Sowers, the head of Hopkins, said the health system canceled its contract with CareFirst because the rates the insurance company Hopkins pays for providers’ services are 40 percent lower than other big companies like Cigna and Aetna — an inequality , which he described as unsustainable.

“We felt like we had reached a point where we were so far apart that we really had to give them that communication,” he said.

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The dispute comes just before many patients are choosing their health plan for the coming year, increasing the pressure on CareFirst. Hopkins and CareFirst are taking calls from affected patients, and in addition to letters and emails, Hopkins a Video with Sowers.

Hopkins and CareFirst officials said care could continue for some people with serious illnesses, rare diseases or certain types of cancer, or for those participating in clinical trials, even if no agreement is reached.

“CareFirst has been a strong advocate that Johns Hopkins price increases are reasonable in these negotiations, as any additional costs will increase the burden on employers and households already feeling strained in this uncertain economy,” officials said in a statement.

Steven Sacks, 72, a retired longtime Department of Energy employee who is also enrolled in CareFirst alongside Medicare, speculated that by terminating the contract pending final talks, Hopkins is putting pressure on CareFirst to act.

“They want to see who blinks first,” he said.

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