Hospital dispels ER rumors

By Christina Calloway

PNT senior writer

ccalloway@pntonline.com

Roosevelt General Hospital officials are out to dispel rumors that imply patients will have to pay for the entire trip to the ER out of pocket during ongoing negotiations between a major insurance provider and a local physicians group.

Because Sunbelt Oasis Emergency Physicians, the contracted physicians group that operates the emergency room at RGH, is not in network for BlueCross BlueShield of New Mexico, patients with BlueShield have brought forth concerns to the RGH administration about footing the remainder of the bill the insurance doesn’t cover.

Hospital CEO Larry Leaming said this is not the case.

“Whatever the difference is, they’re going to write it off,” Leaming said of Sunbelt Oasis. “If there is confusion, bring the bills in and we’ll help you. We’re trying to get on the forefront of this issue.”

Leaming said the physicians group is negotiating with BlueShield about payments but because the emergency room is under RGH’s roof, it’s giving RGH a bad rap.

“The negotiations have not gone well and it’s affecting us,” Leaming said.

The negotiations only apply to the physicians under Sunbelt and not those employed by RGH, according to Leaming.

Leaming said typically if an insurance provider only pays a portion of the bill, i.e. $200 of a $1,600 emergency room bill; it gives patients the impression that the remainder of the bill is their responsibility to pay.

Sunbelt Oasis Spokesman Bill Yarbrough said whatever payment BlueShield makes toward the bill will suffice for RGH patients and Sunbelt will take care of the rest.

“In this case, we accept payment as payment in full. The patient won’t have to pay anything unless they have a deductible or copay,” Yarbrough said. “They don’t get a remainder bill.”

According to a BlueShield handout for patients issued in the emergency room, BlueShield should send a payment directly to the patient for their visit that day.

Once the patient receives the payment from BlueShield, they are asked to endorse the check and send it back to BlueShield along with its accompanying explanation of benefits, according to BlueShield.

Leaming says although this process puts a lot of responsibility on the patients, this is the only way Sunbelt can receive payment for its services right now.

“It’s in the best interest of the patients because we don’t want them to pay more, whether we’re in network or not,” Yarbrough said. “It helps us charge the hospital less if we don’t formally participate with BlueShield.”

Leaming said some of the more ridiculous rumors include patients being at risk of getting turned away because of their insurance provider.

“We will never refuse emergency services to anyone, you’re going to get treated no matter what,” Leaming said.

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