Glen Rose Medical Center Still Not Collecting Blue Cross Blue Shield for Insourced Labs (MMP) (8/2019) Somervell County Salon-Glen Rose, Rainbow, Nemo, Glass....Texas


Glen Rose Medical Center Still Not Collecting Blue Cross Blue Shield for Insourced Labs (MMP) (8/2019)

29 August 2019 at 11:25:00 AM


Glen Rose Medical Center not getting reiumbursed for outside lab work- Why?

Is the Issue with Lab Outsourcing an Insurance Contract Issue, Fraud or What? (Glen Rose Medical Center)

Video from Texas House & Senate Committees re: Rural Hospitals 2019

In May 2019, Michael Honea explained to Somervell County Hospital District that they were not being reimbursed for lab fees by Blue Cross Blue Shield Texas. Essentially, Honea had a deal with Medical Management Professionals that farmed out labs to Glen Rose Medical Center, with the labs originally contracted out at other locations not in Somervell County. 

From the May 30 2019 meeting

Rough Transcript: (Watch video for exact) 

Honea: Really not too much on the lab outsource side. We're still kind of where we are, large number of claims to BCBS for review, they have those and I haven't heard back on those yet and we're waiting to hear back on that. On aother note HB 3934, the bill for rural hospitals to cooperatively negotiate contracts with commercial payers made it through the Senate, sitting on the governor's desk. ... There hasn't been a whole lot of movement one way or the other

June 27, 2019
Rough Transcript
Honea: Kind of some good news. The bill we tried to get through has been signed by the governor, allows rural hospitals to combine together to negotiate a single contract with Blue Cross. Moving parts, still trying to figure out how that's going to be structured, working with Torch, 160 hospitals. I don't see that coming to life within a year. MMP is scaling down and going to hold off specimens for awhile. Volume was kind of, not a whole lot there, side burner there,.Blue Cross, nothing has changed there.
Reynolds: Blue Cross is not paying. They're .. MMP, requesting records on most of our therapy claims, which is delay billing, continuous struggle. We met with the attorney yesterday to see what next step is with negotiations with BC. With our contracts, they're not even willing to consider our contract until we get these issues resolved with lab and therapy. No movement there at all. They are paying for other services, only MMP, outpaitient lab and therapy we're not being paid yet with Blue Cross, our biggest payer. 
Pat: How long has that been going on?
Honea: Labs been going on for over a year.  March.... 
Reynolds: TDI is not willing to take any action with our claim, same way they handled the one in ? Trying to decide what our next step is
Honea: They're doing what they call prepayment review, they're not paying us and according to the contract, they're supposed to review it but they've taken a stance that they are not even going to pay. Politics. 
Reynolds: Continue to accept payments from other payors and ride it out with BC (?) Attorney and consultant who is attempting to negotiate our contract with BC but no action taken until we get the billings issues solved.
Margaret: Less lab work, too much staff now? 
Honea: We have staff down, several we haven't replaced. as it goes down a little more, probably another one. Still paperwork, looking at scaling down. 
Steven: Any reason to potential of a much more favorable outcome negotating? 
July 25, 2019
Rough Transcript:
Honea: On lab outsource and Blue Cross, I really don't have a lot to report. There haven't been any significant changes but I think we're getting closer to some happening. During the process, there's been (?) MMP side ... them looking to meet with a legal firm and they've been out of the country for a period of time but they're due back tomorrow so I would expect once they have that meeting we'll see whether  (?) Not a whole lot of movement, not a lot of communications there. I do know we had a meeting with Humana earlier this week and that meeting went really well. I would expect in the next month to see a little bit of movement 



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