Some 12,000 Berkshire Health System patients will have to find new insurance since Boston Medical Center HealthNet Plan ended its coverage.

PITTSFIELD, Mass. — Some 12,000 local patients need to find a new insurance company or change plans.

 

Boston Medical Center HealthNet Plan ended its coverage of patients at Berkshire Medical Center, Fairview Hospital, the Berkshire Visiting Nurses Association and Hospice and other Berkshire Health Systems affiliates. 

 

"Berkshire Health Systems is disappointed that BMC HealthNet has chosen to terminate its coverage for patients of BHS, but with their similar termination with Baystate Health System last year it was not a surprise," said BHS spokesman Michael Leary. 

 

BMC HealthNet is an insurance arm of Boston Medical Center that specializes in Medicaid coverage. In December, the insurance company stopped covering Baystate Health Systems and its affiliates because of costs. Before that, the company ended its relationship with Children's Hospital in Boston.

 

Kevin Klein, BMC HealthNet's chief marketing and sales officer, said the separation from Berkshire Health Systems was for same reason as the others — rates. 

 

"Berkshire Medical Center and Fairview Hospital are our highest-cost facilities in Western Massachusetts, and we have been losing money in the Berkshire service area for several years; this is not sustainable in the long term," Klein said. 

 

"We also pay Berkshire-owned doctors significantly more than the MassHealth fee schedule, though we did not request a change in these rates. As a result, we issued a letter of non-renewal to Berkshire with the intent of achieving rate alignment, and Berkshire indicated that they are not able to accept a rate reduction and have accepted the termination."

 

Essentially, BMC HealthNet said it is trying to strike a balance between what the insurance company has been reimbursing Berkshire Health Systems for and what the state has been contributing for Medicaid and MassHealth patients.

 

Klein said the insurance company posted a $43.3 million operating loss in 2014 while Berkshire Health Systems reported some $14 million in operating income.

  

"We are one of, if not the lowest cost health plan in the state from an administrative standpoint. Nearly 93 cents of every dollar we get from the state goes to paying for care for those who need it," Klein said.

 

Leary said there are other insurance companies that will pick up the patients in the Berkshires so residents won't have to change doctors.

 

"We are fortunate that there are five alternative Medicaid Insurance providers in our region who will accept new patients so that they can continue to see their existing healthcare professionals. They are: CeltiCare, Health New England Be Healthy, MassHealth Primary Care Clinician Program, Neighborhood Health Plan and Tufts Health Plan Network Health," Leary said. 

 

"We have notified our patients impacted by this change and are helping them as needed to navigate the process of choosing another provider. We are committed to continuing to provide the highest level of care for all patients in the region."

 

In Springfield, the Baystate Health breakup affected about 50,000 residents in that region but the insurance was still accepted at nearby hospitals like Holyoke Medical Center, Noble Hospital and Cooley Dickinson. In the Berkshires, there are no other options so patients need to change insurance plans or providers.

 

Klein said BMC HealthNet doesn't want to lose its connections in the Berkshires and is hoping to retain as many members as possible through changes in coverage.

 

"This will impact our members in Berkshire County, so we are working with the state to make the transition as smooth as possible and to assure continuity of care for them. We also hope to retain as many of those members as possible," Klein said. 

 

"Those who choose to change coverage will have the option to select either another health plan or the state's health plan, though neither will necessarily benefit the Berkshire [Health] system. Berkshire [Health] has been a valued business partner for a number of years, so we remain hopeful that they will find a way to collaborate with us in the future."