NORTHAMPTON — Around 2,500 area residents with Blue Cross Blue Shield Medicare Advantage are being notified that their insurance will no longer cover primary care providers affiliated with Cooley Dickinson Hospital beginning Oct. 1.
Even though many people this month are receiving letters from Blue Cross Blue Shield stating, “Important notice: your health care provider is leaving your plan’s network,” a spokesperson for Cooley Dickinson Hospital on Wednesday said the hospital is assuring patients they will continue to receive care.
Still, the notices bring significant uncertainty depending on the type of plan a patient has. The change affects only Medicare Advantage HMO plans, which will no longer cover primary care providers affiliated with Cooley Dickinson Hospital. Members with Medicare Advantage PPO plans — a larger share of those affected in the region — will still have their coverage honored, though with higher co-pays.
One frustration for those affected is that they can’t change plans until open enrollment begins on Oct. 15. New plans, through companies like Aetna, won’t take effect until Jan. 1 — potentially leaving affected patients without primary care for nearly three months.
However, Blue Cross Blue Shield spokesperson Kelsey Pearse said there is a “continuity of care” provision in the plans that allows patients to maintain their primary care doctors for a period of 90 days.
Mass General Brigham, which owns Cooley Dickinson Hospital, issued a statement on Wednesday that Blue Cross Blue Shield had notified it that its western Massachusetts primary care providers would be excluded from their network for BCBSMA Medicare Advantage plans, beginning Oct. 1.
“We recognize the disruption this change may cause and are advocating on behalf of our Medicare Advantage patients,” reads the statement provided by Kelly Mitchell, public affairs program manager. “We are working to notify impacted patients and inform them of their other Medicare insurance options. We encourage impacted patients to contact BCBSMA directly for questions on their coverage.”
Pearse, though, said the decision to have primary care providers be moved out of network was made by Mass General Brigham, and that otherwise members’ coverage and insurance remains fully active.
“It really was their decision,” Pearse said.
The two organizations offer conflicting accounts of who initiated the change.
Blue Cross Blue Shield issued a so-called holding statement in which it said the insurance company was notified by the Cooley Dickinson Physician Hospital Organization that a restructuring of business operations was prompting an end to the hospital’s participation in its Medicare Advantage network.
“This means most CDPHO primary care providers will no longer be in our Medicare Advantage network,” the statement reads. “However, most specialty providers, including those from the Cooley Dickinson Medical Group (CDMG), which is owned by Mass General Brigham (MGB), will continue to participate in Blue Cross’ Medicare Advantage network.”
Cooley Dickinson Medical Group providers also remain in Blue Cross’ commercial network.
“We are committed to ensuring members have the resources they need to navigate this change,” the statement continues. “Members should first check with their provider’s office to see if they will remain in-network. They can also call the number on their member ID card so our team can verify if their provider remains in-network, or help them find a new participating provider.”
Sen. Jo Comerford, D-Northampton, said in a phone interview that she is engaging with the hospital and Blue Cross Blue Shield to learn more about what is happening.
“I believe the situation is in flux,” Comerford said. “It’s quite serious. I’ve offered Cooley Dickinson my full support in engaging with Blue Cross Blue Shield.
“We cannot have large numbers of patients without access to primary care,” she added.
Comerford also spoke with Dr. Kevin Whitney, Cooley Dickinson’s chief operating officer, as part of her effort to reach “a fair resolve for her people,” as her office described it.
In addition to the specialty and hospital care remaining in-network with Blue Cross Blue Shield’s Medicare Advantage PPO plans, patients may also visit Mass General Brigham Express Care for non-life-threatening illnesses or injuries in Northampton, Amherst, Southampton and Greenfield.
