3,500 HealthAmerica subscribers may lose Altoona Regional coverage
By William Kibler, bkibler@altoonamirror.comAbout 3,500 regional subscribers to HealthAmerica health insurance may lose coverage at Altoona Regional Health System before the end of the month.
The hospital recently told the health plan that it will terminate the agreement that determines how much HealthAmerica pays the hospital for services rendered to policy holders because the parties can't agree on a new deal, according to HealthAmerica.
"HealthAmerica has proposed a reimbursement that is comparable to other hospital contracts in the area," the health plan stated in a letter to a local employer that participates in the plan. "Altoona declined the offer, demanding an exorbitant increase."
"We are asking for what we feel is fair payment," hospital spokesman Dave Cuzzolina said. "We have a responsibility to the community to negotiate sufficient reimbursement to maintain the highest quality care."
The hospital long has complained about inadequate reimbursement, especially from Medicaid and Medicare, and ended the recent fiscal year with an operating deficit of about $2 million, pending an audit.
"HealthAmerica group customers and members could expect to see significantly higher medical care costs if HealthAmerica accepted Altoona's proposal," health plan spokesman Kendall Marcocci said. "This, in turn, could make the cost of health insurance less affordable for Blair and Cambria county groups and could contribute to the number of uninsured."
The two sides continue to negotiate.
If they don't reach an agreement, preferred provider, point-of-service and health maintenance organization policyholders would need to pay high out-of-network charges if they continue to go to Altoona Regional facilities after Sept. 26.
Policyholders who receive active treatment can apply to continue at Altoona under the old terms for up to 90 days, Marcocci said.
The health plan will pay under the old contract for emergency care at Altoona.
HealthAmerica policyholders who want to continue receiving coverage for care at Altoona can pick from a variety of other health plans, as the hospital contracts with most other major carriers, Cuzzolina said.
Those who want to stick with HealthAmerica can get treatment at Memorial Medical Center and Good Samaritan Medical Center in Johnstown, J.C. Blair Memorial Hospital in Huntingdon, Mount Nittany Medical Center in State College, Nason Hospital in Roaring Spring, Tyrone Hospital, UPMC Bedford Memorial Hospital and Select Specialty Hospital in Camp Hill.
Employers can get out of their contracts with HealthAmerica after 30 days notice, but HealthAmerica encourages any so inclined to discuss the move first, Marcocci said.
Altoona Regional has never broken with a health plan, but pre-merger predecessor Altoona Hospital parted from Geisinger Health Plan several years ago, nudging that company to work out a deal with then-rival and now merger mate, Bon Secours Hospital.
Altoona Regional and HealthAmerica have been negotiating a contract renewal for several months, Marcocci said.
Mirror Staff Writer William Kibler is at 949-7038.
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SCHart
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09-04-08 6:19 PM
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What do you mean may? I all ready got our letter...even tho we switched near a yr ago...
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MeerReedr
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09-04-08 7:24 AM
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Did you ever notice that the very first question you're asked when you call your doctor's office or a hospital is not "How may we help you?", or "How are you feeling?", or even "Are you dying?". No, it's always "What is your insurance?". Sad.
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