New Blue Cross Blue Shield Plan Steers Patients To Cheaper Hospitals

If you live in Massachusetts and have Blue Cross Blue Shield health coverage, you may end up paying more if you want to go to certain hospitals.

BCBS of Massachusetts, the state’s largest insurer, recently began selling a new plan which comes with a smaller hike in insurance premiums (4.5% compared to 10%) but also tacks on extra fees if patients go to certain pricier hospitals.


The Blue Cross Hospital Choice plan, which went on sale last month, charges members, for example, an extra $1,000 for an inpatient stay or outpatient surgery, and $450 more for an MRI, at 15 higher-cost hospitals, including Massachusetts General and Brigham and Women’s hospitals, Children’s Hospital Boston, and UMass Memorial Medical Center in Worcester.

The insurer says the plan is already a hit with many businesses in the state. In January, 30% of small businesses and individuals up for renewal opted for the Hospital Choice plan.

Proponents of this type of plan say they “really help the employer and the employee start to understand what is driving health care premiums higher… Simple things, like MRIs and CAT scans, if you’re just able to stay out of those hospital settings, that can save money. It helps everybody.”

Opponents worry that, by pushing patients away from procedures at the more expensive hospitals, those same hospitals will have trouble subsidizing money-losing services that are funded by such procedures.

Additionally, some of the hospitals on the list, like Saint Anne’s in Fall River, MA, feel they are being wrongly singled out because of their areas of specialization. Execs at Saint Anne’s say it looks expensive on paper because it is the largest provider of oncology services in its region and cancer treatment is not cheap.

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