Blue Cross loses contract with Henderson hospital

Wednesday, Aug. 9, 2000 | 10:45 a.m.

Officials for Anthem Blue Cross Blue Shield of Colorado and Nevada say they intend to grow in Southern Nevada despite indicators to the contrary.

Contract renewal talks broke down last month between the health insurance company and St. Rose Dominican Hospital in Henderson, which has contracts with every other major insurance provider that serves the area.

That leaves Anthem Blue Cross Blue Shield contracted with just four local hospitals: Sunrise and Mountainview, both owned by HCA: The Healthcare Co.; Valley and Boulder City.

Anthem officials say the four hospitals and one hospital company with whom they are contracted, Valley owner Universal Health Services; "have adequate capacity" to care for the 65,000 Las Vegas-area Blue Cross Blue Shield clients.

St. Rose, in a July letter to its patients who are covered by Anthem, said: "It is worth noting that of the 11 hospitals in Southern Nevada, only four remain under contract with Blue Cross."

"Anthem Blue Cross Blue Shield is committed to increasing its presence in Nevada," said Dr. Stan Borg, an osteopathic physician and a vice president for Anthem Blue Cross Blue Shield of Colorado and Nevada. "We want to offer Southern Nevada quality services and affordable options."

He said his company is trying to bring two more local hospitals into its network, Desert Springs and Summerlin -- both of which are part of Valley Health Services under the auspices of Universal Health Services.

Ray Brown, spokesman for Universal, said it is expected that the Anthem contracts with Summerlin and Desert Springs will be completed by September. And, he said, his company, the third largest privately held hospital system in the nation, with 72 facilities in 20 states, is happy with Anthem's services.

"We are very pleased with the existing contract we have with them through (a 10-year-plus relationship with) Valley Hospital and we are very optimistic it will be better for Desert Springs and Summerlin Medical," Brown said. "We have received good reimbursement from them."

Brown said his company's deal with Anthem may be better than what St. Rose was offered because Valley, Summerlin and Desert Springs have significantly more beds than St. Rose.

Shauna Walch, spokeswoman for St. Rose, says Anthem offered nowhere close to the contracts the hospital worked out with the other big insurance companies.

"They (Anthem) did not offer us reasonable market rates," she said. "There has to be a common ground, and they did not meet a reasonable level of reimbursement. But we have had real positive negotiations with the other providers."

Anthem and St. Rose say they have agreed to return to the bargaining table, but no date has been set.

Officials for both St. Rose and Anthem, which also is the Blue Cross and Blue Shield licensee for Indiana, Kentucky, Ohio, Connecticut, Maine and New Hampshire, say local Blue Cross Blue Shield patients can use emergency room services at both St. Rose campuses -- St. Rose de Lima or St. Rose Siena -- and be fully reimbursed.

In November 1999, Indianapolis-based Anthem Inc. paid $155 million for Colorado Blue Cross Blue Shield, which had purchased Nevada Blue Cross Blue Shield in 1996.

As part of the agreement, the Caring for Colorado Foundation was created and the purchase price was paid to the charitable trust that benefits only Colorado citizens. In effect, Nevada got nothing from the sale.

On top of that, Blue Cross Blue Shield went from a non-profit to a for-profit company -- a move that upset some Nevada lawmakers who felt the company owed the state for financial breaks it had received as a non-profit business.

A bill aimed directly at Blue Cross called for the company to reimburse Nevada $28 million. It passed the Assembly unanimously but, in the waning days of the Legislature, died in the Senate for lack of a vote.

"I still think we did the right thing -- it was a good bill," said Assemblywoman Chris Giunchigliani, D-Las Vegas. "They took money out of the state in a duplicative manner and left us hanging."

Giunchigliani said she believes there is "still an appetite" in the Assembly to resurrect the bill in the next legislative session. Or, she said, the Nevada Attorney General's office could "be implored to look into" the matter.

An effort by a Nevada consumer representative to get a piece of the purchase money was thwarted by Colorado Commissioner of Insurance William Kirven, who denied a request to transfer a portion of the $155 million to a Nevada foundation.