Landmark Medical Center of Woonsocket, RI is claiming that the state's largest insurer, Blue Cross Blue Shield, owes the hospital $4.5 million in unpaid reimbursement rates. After years of wrangling with the insurer, yesterday Landmark's board of directors voted to allow hospital president Gary Gaube to take the necessary steps to receive the reimbursements, including filing a lawsuit if needed. Landmark also wants higher future reimbursement rates, totaling an additional $4.5 million. A spokesperson for BCBS said that it has met all its contractual obligations.
This isn't the first time there have been complaints about BCBS reimbursement rates in Rhode Island. The insurer recently increased rates, particularly for doctors. But Landmark--which received several one-time payments to compensate for previous underpayments--claims BCBS has not increased its rates. "This is very clever and shrewd," Gaube told The Providence Journal. "They gave us one-time adjustments. They didn't build on the rates--[the increases] weren't perpetuated into the future."
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PLUS: Rhode Island is taking steps to improve the overall condition of its healthcare system, with legislation to manage ever-increasing healthcare costs as well as improve preventative care working its way through the state house. Provisions of the bill include reducing small business insurance costs, providing easier access to primary care and increasing data transparency to help consumers make healthcare decisions. The also takes preventative measures by restricting junk food sold in schools and expanding smoking-cessation programs. Report