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Premera’s word on Ballard Emergency Physicians

September 1, 2009 in medical | 8 comments

Continuing my effort to keep people updated on Seattle’s emergency rooms, the ER physicians and insurance coverage, I thought I’d let you know that Premera announced the following in their July 2009 Producer Bulliten (PDF here, bolding mine.)

Ballard Emergency Physicians Rejoin Network

Ballard Emergency Physicians have signed an agreement to be part of the Premera Blue Cross provider network, effective August 1. The physician group provides emergency room services for Swedish Medical Center in Ballard.

Please note that Swedish Emergency Physicians (SEP), the physician group providing emergency room services for Swedish Medical Center on First Hill, is not in the Premera provider network. As a result, members seeking emergency care at Swedish Medical Center on First Hill may experience higher out-of-pocket costs for emergency physician services. Swedish Medical Center is a contracted facility, so facility charges and services received from physicians and providers other than SEP are considered in-network and will be paid accordingly.

See previously under the Ballard Emergency Physicians tag.

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Pet Peeves: Stop!

August 6, 2009 in Uncategorized | 1 comment

Lately, I find myself getting peeved at intersections, whether on foot, or in the car. Maybe I’ve just never noticed it before moving to Seattle, but my experience here, consistently, is that few drivers or bicyclists recognize or heed the red light or stop sign. I’ve caught myself at least twice in the past week, pointing to the stop sign when I’ve clearly had the right of way, and when I was in the middle of either walking or driving across the street. Both times were at stop signs, and I saw people literally roll through, and in some cases, I see people not even feign stopping. It’s like the signs don’t even exist.

I find myself a little tense when driving near intersections, especially if there’s a light turning yellow in front of me. Twice yesterday, as I saw it turn yellow, well within stopping distance, I slowed to a stop while the person in front of me drove through, not even accelerated, a fully red light. These were two different occasions. I get tense specifically because I’m scared one of these days when I’m dutifully stopping at a traffic light or sign I’m going to be rear-ended, because clearly, I’m not part of the norm.

I think to myself – do they not have driver’s ed here? Are the rules different in Washington? I was taught that you stop at the stop line, and if there is no stop line (which there aren’t in Seattle, I’ve noticed) you stop at the place where the stop sign is, then roll forward to make your turn or wait to get through traffic. Those who do stop never stop at the stop sign, but always near or past the curb, slightly into the intersection.

As a pedestrian, this is what bothers me the most – there is no buffer at many of the side streets for crossing safely. Those who disregard the stop sign have me training myself to not only look both ways before crossing, but to not trust that the stop sign means they will actually stop. I actually had a woman in an SUV look me square in the face with what I hope to be self-conscious horror as she blew through a stop sign and stopped short of hitting me by about 5 ft.

People in Seattle can’t be totally dim as to the rules, with a point in their favor being at 4 way stops, where I will see people minding the rules of dealing with 4 way stops.

Then there’s traffic circles – but perhaps that’s another rant for another day. If only our traffic circles had the handy diagram signs that Chicago’s traffic circles in Rogers Park has.

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Notes from Swedish Ballard and Premera

August 5, 2009 in medical, personal

I’ve been trying to get more information on the agreement reached between Premera and the Ballard Emergency Physicians (the contracted doctors for Swedish Medical Center – Ballard’s ER). I emailed Rayburn Lewis MD, Executive Director and Senior Medical Director of Swedish Ballard, and Eric Earling, PR representative for Premera. Rayburn Lewis MD stated:

According to the medical director of our emergency department, the contract takes effect tomorrow, August 1,2009…These contract negotiations have been pursued by Ballard Emergency Physicians for quite some time, and I am sure that input from consumers and Swedish as well as the persistence of the physician group was influential on the decision.

Dr. Lewis let me know that Premera was expected to make a formal announcement in their newsletter about the agreement. He also let me know that he could not speak for any of the other Swedish Medical Center facilities and physicians with regard to any agreements between them and Premera.

I contacted Eric Earling to get a press release for the new agreement. The only information I got was a confirmation that the agreement between Premera and the Ballard Emergency Physicians went into effect August 1, 2009. I’ve requested a copy of the official announcement when it is released.

On a personal note, I received my official denial of my second appeal from Premera a few days ago. It did note that there was not an agreement between the Ballard Emergency Physicians at the time of service or at the time that the letter was written. I called the representative for Premera and left a message to inquire if the new agreement should make a difference to my appeal.

What can I say, my curiosity into this system has been piqued, and I can’t help but delve deeper to understand how this crazy system works.

See previously under the Ballard Emergency Physicians tag.

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One Step Closer, with new information.

July 30, 2009 in medical

I received this response to my post Swedish Ballard Promotional and Update on Appeals:

I appreciate the comments made above and understand the frustration regarding whether or not a physician group contracts with a particular health insurer. Ballard Emergency Physicians has recently reached agreement with Premera. Both Swedish/Ballard and the Ballard Emergency Physician group are now participating providers for Premera medical insurance programs. Feel free to contact me if you have any other questions.

Rayburn Lewis, M.D.
Executive Director and Senior Medical Director
Swedish/Ballard

As I have in previous posts – I will extend thanks to Rayburn Lewis, MD, for taking the time to visit and read my post, and respond personally. I’ve sent him a rather slapdash email asking for more information. Let’s face it, I’m a low-level blogger, not some pro-aspiring-journalist. I know some people have been landing on this blog thanks to Google searches, so I hope to give you the most up-to-date info as I get it.

As for my appeal – I finally heard back from Premera on my second appeal. Not surprisingly, they denied my claim, but were sympathetic in doing so. Apparently, I have a packet of info in the works, with additional appeal information (it doesn’t stop at 2?!) I called the Ballard Emergency Physicians billing office (of Oklahoma City, OK), and they seemed unfamiliar with the agreement, and weren’t aware of any implications the agreement would have on my bill. They did, however, give me a “courtesy discount” of 30%, making the final bill smaller, but still above what it would be if it was billed in-network.

I have a bit more digging to do, but this odyssey is nearing its end, I think. This wasn’t really about lowering my own costs, though that is a benefit – it’s about the principle. I’m sick of hidden charges and fees. I’m sick of a system where you can’t leverage the principles of capitalism in the market place to ensure the best deal. You walk into any ER, and you can spend the same amount of time seeing a doctor, get the same tests, and end up with a radically different bill at any given time.

Today, a woman I talked to at Premera WAS able to give me, over the phone, a list of hospitals that do not have contracted providers in their ER (a previous representative was unable to do so months ago.) Luckily, if what Dr. Lewis is saying is correct, this has changed for the hospital nearest to me.

If the people in the health care industry are so scared of reform – then I ask the health care industry to reform itself so legislators don’t have to. The current system is broken, it wastes money, it sets pricing at ridiculous levels, and even non-profits get tied strongly to the profit base. I don’t have the answers, but I, like many people, have some ideas. I prefer companies that have the sense to carry internal ethics, and hold true to practicing them than other agencies having to tell them to do so. Step up, I say!

Anyway – I’m done messing with medical stuff today. After all, it’s hot out there! I need to drink more water and get myself to the library!

See previously: Emergency Room Charges, Ballard Emergency Physicians and Swedish Ballard Emergency Room, Insurance, Emergency Room and Complaints/Appeals, Insurance Appeal Update, Ballard Emergency Physicians Update, Swedish Ballard Promotional and Update on Appeals

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Swedish Ballard Promotional and Update on Appeals

July 25, 2009 in deliberate consumption, medical | 1 comment

Swedish Medical Center – Ballard has a bunch of new signs outside, among which enlighten people that yes, Ballard has an emergency room this side of the Ballard Bridge. That is, unless you want to travel to Unversity of Washington Medical Center or Northwest Hospital.

I admit to wanting to put up a sign nearby, reminding people that if they have Premera (the largest insurer in the state of Washington) their ER visit will have the facilities at Swedish Medical Center – Ballard be charged as in-network, but the Ballard Emergency Physicians services will be charged as out-of-network, meaning higher costs to the consumer. I cannot stress enough that people need to be informed of this, outright – and if you have the minutes to spare in an emergent care situation – make the choice to go anywhere but Swedish. I have it from another friend that the main Swedish campus also has contracted physicians that DO NOT TAKE Premera for their ER services.

In other news, I haven’t heard back on my second appeal with Premera, but I have gotten a reduced bill from Ballard Emergency Physicians. It’s still 2x what is the maximum allowed amount by my insurance. The complaint to the Department of Health is at a standstill until I authorize the release of my identifying information. I’m still thinking about that one. No word yet on the Attorney General’s office. We’ll see.

Have a great weekend, everyone!

See previously: Emergency Room Charges, Ballard Emergency Physicians and Swedish Ballard Emergency Room, Insurance, Emergency Room and Complaints/Appeals, Insurance Appeal Update, Ballard Emergency Physicians Update.

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