by Dennis Dalman
editor@thenewsleaders.com
Kindergarten teacher Sarah Gill, a single mother of three, was devastated when she learned recently that Blue Cross and Blue Shield of Minnesota will no longer pay for treatments for her 2-year-old son at Sartell Pediatrics.
As an Oak Hill Elementary School teacher, Gill’s insurance carrier is Blue Cross/Blue Shield.
The payments for Sartell Pediatrics’ care will cease starting Feb. 1.
And Gill is not alone. The decision by Blue Cross/Blue Shield will affect 1,500 patients of Sartell Pediatrics. That is because that insurance giant contracts with Integrity Health Network, which in turn contracts with 20 clinics in Minnesota, including Sartell Pediatrics, to cover the cost of patient services.
Gill shared her dilemma at a Nov. 15 press conference held at Sartell Pediatrics with fellow speakers being Dr. David Smith, owner-operator of the clinic; Jill Smith, clinic administrator; and Jeff Turner, president of Integrity Health Network.
The Blue Cross/Blue Shield decision was a bolt from the blue. The only reason it gave for the contract termination was a two-word explanation, “business decision,” according to Sartell Pediatrics.
In the meantime, the Smiths sent a letter to all of their patients to inform them since many had no idea of the cancellation. Even though Blue Cross/Blue Shield apparently made its contract cancellation in late August, it made no attempt to notify clinics or patients of the decision, according to the Smiths. The decision ended 18 months of negotiations between Blue Cross/Blue Shield and Integrity Health Network.
The Smiths, too, were devastated about the news because they know how it will affect so many of their patients who will suddenly feel desperate, at loose ends. That is why the Smiths are informing people and raising widespread awareness about the problem. People are now in the midst of the enrollment period for choosing a health care insurance plan through Internet exchanges or elsewhere, Jill Smith noted.
The Smiths want people to know Blue Cross/Blue Shield has dropped its contract with Integrity Health Network and will not be covering services at Sartell Pediatrics or many other clinics. Too many, Smith said, will choose that insurance plan and be completely unaware of that lack of coverage. She is recommending people choose a plan that will definitely cover their families. For example, Sartell Pediatrics, to name one, will accept insurance policies that include Medica, HealthPartners and Preferred One, to name three.
“It’s not right,” Jill Smith said of Blue Cross/Blue Shield’s silence about its decision. “We wanted to inform all our patients. We didn’t want them walking in here Feb. 1 only to find out they are not covered anymore.”
When choosing insurance coverage, people should be sure it will cover the physician and clinic they need and want, Smith advises.
The Blue Cross/Blue Shield was especially disappointing, Jill Smith said, because Sartell Pediatrics provides care at lower costs. In October, the clinic ranked as the fifth-lowest cost of similar clinics in the state.
Gill and Aden
Sarah Gill, 34, has been a kindergarten teacher at Oak Hill Elementary for nine years. Two years ago, her husband died, leaving her to raise three children – Eli, 6; Sophie, 5; and Aden, 2.
Aden was born with congenital diaphramatic hernia and had only a 50 percent chance of surviving. He spent 102 days at University of Minnesota’ Masonic Children’s Hospital.
Now nearly 3, he is doing “wonderfully,” his mother said, although he needs lots of follow-ups, including ones at Sartell Pediatrics.
“We love the Smiths, and we love going to their clinic,” Gill said.
Now, with insurance coverage for Aden’s treatments gone, Gill does not know what steps to take. As if that weren’t bad enough, she also recently discovered the contract between Fairview Hospital (where Aden goes) and Blue Cross/Blue Shield was also terminated.
“I think I’m in denial at this point,” she said. “But I’m going to start looking around.”
She has written Blue Cross/Blue Shield about her plight but is not overly confident of a good outcome.
Write letters
In her letter to patients of Sartell Pediatrics, Jill Smith explained the problem and then encouraged them to write letters to the following to raise awareness and to ask for positive outcomes:
Mr. Michael Guyette, CEO
Blue Cross and Blue Shield of Minnesota
3535 Blue Cross Road
Eagan, Minn. 55122‐1154
michael.guyette@bluecrossmn.com
Dr. Ed Ehlinger
Commissioner Minnesota Department of Health
P.O. Box 64975
St. Paul, Minn. 55164‐0975
health.commissioner@state.mn.us
Mr. Mike Rothman
Commissioner Minnesota Department of Commerce
85 Seventh Place E., Suite 500
St. Paul, Minn. 55101
general.commerce@state.mn.us
A press conference at Sartell Pediatrics Nov. 15 spelled out the crisis caused by a canceled insurance contract by Blue Cross/Blue Shield. From left to right are Sarah Gill, single mother of three and kindergarten teacher; Dr. David Smith, owner-operator of Sartell Pediatrics; Jill Smith, clinic administrator for Sartell Pediatrics; and Jeff Turner, president of Integrity Health Network.
Kindergarten teacher and single mother of three Sarah Gill (left) talks about the quandary she and her children are in after Blue Cross/Blue Shield canceled its contract with a network provider at Sartell Pediatrics. At right is Dr. David Smith, owner-operator of Sartell Pediatrics.
