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Johns Hopkins warns it may split with Maryland’s largest insurer CareFirst – Baltimore Sun

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Doctors at Johns Hopkins hospitals, surgery centers and community physicians offices soon may no longer accept insurance from one of the state’s dominant insurers, CareFirst BlueCross BlueShield, limiting access to or raising costs for some of the region’s most in-demand medical providers.

Johns Hopkins and CareFirst BlueCross BlueShield have so far failed to reach an agreement over the portion of patient bills that goes toward physicians, other providers and potentially other fees, though not direct hospital services.

Hopkins began notifying 350,000 regular and recent patients today by email or through the US Postal Service that they may no longer be “in network” as of Dec. 5, though anyone with CareFirst insurance could be affected.

“Hopkins, and I believe CareFirst, are both committed to serving the community we live in and the citizens of Maryland, but when I step back and put my fiscal hat on, I need to make sure we have a sustainable business model,” said Kevin Sowers, president of the Johns Hopkins Health System and executive vice president of Johns Hopkins Medicine.

In a statement to The Baltimore Sun, CareFirst officials also said they are working toward a resolution before the contract ends, and noted nothing changes for beneficiaries for 90 days. They also said Hopkins initiated the end to the contract.

“We regret Johns Hopkins’ decision to terminate our existing contracts and do not agree it was necessary to put the people we collectively serve in the middle of an ongoing negotiation,” the statement reads. “As we continue to discuss how best to improve access, affordability, quality, and equity in healthcare together, our shared commitment to community and long-standing history of collaboration gives us hope that our partnership will continue.”

Both sides said rising costs are an issue. Sowers said that when he started looking at contracts with all of Hopkins’ biggest insurers, he found the cost of providing health care rose 21% over the past decade, but the CareFirst rate increase was only 10%. CareFirst also was paying less than other insurers, he said.

CareFirst said Hopkins was requesting rate increases that exceeds the rate of inflation. CareFirst also said it may be unfair to compare it to other large insurers because, unlike CareFirst with a wide range of services across Maryland, other large carriers are for-profit, out-of-state companies that can “pick and choose the communities they serve.”

Sowers said he was required by law to give CareFirst 90 days notice that Hopkins doctors would go out-of-network, though he said his “hope and goal” still was to settle on a new contract. He cited “transparency” in deciding to send messages to patients alerting them of the possibility in-network coverage would end, answer basic questions and set up a special call center. It will be open from 8 am to 5 pm on weekdays at 443-997-0549.

The patient letter, provided to The Baltimore Sun, begins: “Because you are a patient at Johns Hopkins Medicine, your health is our highest priority. That is why we need to let you know that your Johns Hopkins doctors, nurses and caregivers may have to leave the CareFirst network as soon as December 5, 2022. As a result, CareFirst may cover less, or none, of the care you receive at Johns Hopkins starting on December 5, 2022, leaving you to pay more to see your doctors, nurses and caregivers.”

Specific costs to patients would depend on a person’s insurance policy, complicating answers about exactly what would be covered. Some plans cover a portion of out-of-network costs while others cover nothing. The letter to patients advises them to call the number on the back of their CareFirst insurance card with questions about coverage.

Another complications is the costs also depend on where a person got the care.

The rates for direct hospital services are set by the state under a unique agreement Maryland has with the federal government as a means of improving health care and controlling costs. Unlike in other states, official hospitals in Maryland don’t negotiate those, and all public and private insurers pay the same rate at a given hospital.

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This system is why patients often receive more than one bill for a hospital visit.

If the contract ends, care performed in hospitals, including Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center in Baltimore, would stay in network. That likely would include associated lab work and facility fees, provided they are performed in the hospital.

For the most part, doctors and other providers in those hospitals would be out of network if a patient sees the providers in the hospital or is admitted. The exception are doctors in the emergency room under the rules in Maryland. They’d remain covered.

Doctors in surgery centers and community physicians offices would be out of network, likely along with labs and other fees associated with care outside of hospitals.

Those receiving ongoing treatment for cancer or another condition requiring continuing care could seek approval from CareFirst to continue those treatments at Hopkins at the in-network rates.

Collectively, Johns Hopkins Medicine has more than 2.4 million patients and 280,000 emergency room visits a year, according to its website.

CareFirst reports that it has 3.5 million members in the Mid-Atlantic region and access to 1.7 million providers.

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