Academic Urology Out of Independence Blue Cross Network

Over the last six weeks, many of our patients have contacted IBC to encourage the insurer to negotiate.  We can share with you that, because so many patients made their concerns known, IBC did agree to sit down with us to “listen to our point of view.”  Unfortunately, as of this writing, IBC has maintained its “no negotiation” stance toward Academic Urology. Still, the voices of our patients have made a difference, and we hope you will continue to contact IBC. We are grateful for the support and encouragement that so many of you have shared with us.
 
Our top priority is your health and well being.  Because of IBC’s unresponsive position, however, you should know that it is likely Academic Urology will be “out of network” beginning December 1.  How this status affects you depends on the details of your individual plan with IBC.  Generally speaking, we believe that patients with IBC Personal Choice and Medicare plans will retain some level of coverage for out-of-network services. Non-Medicare Keystone and HMO subscribers will have no out-of-network benefits, except for emergencies. Below is a summary of information provided to us by IBC, and we are including a chart that illustrates “out of network” coverage, as we understand it.  If you are unable to switch to another insurance provider, we encourage you to contact IBC to determine specific coverage levels for your individual plan. Ultimately, IBC has final authority on what it will or will not cover—it is not up to Academic Urology.

•Emergency Care provided in a hospital or in an Emergency Department will continue to be covered according to your individual plan. For patients with commercial IBC plans, such as Personal Choice, Academic Urology will bill you and IBC will reimburse you directly according to its schedule of “reasonable” costs.  For patients with any of IBC’s Medicare-related plans, the insurer will reimburse Academic Urology directly.

•Patients in active treatment will need to request a “continuity of care exception” to have ongoing care covered.  Academic Urology has already helped many patients apply for this exception, and we will continue to do so. IBC reviews each request for an exception individually.  If approved, IBC will reimburse Academic Urology directly while you remain in active treatment.

•For elective, non-emergency, or routine services, Academic Urology will bill you directly and IBC will reimburse you according to the details of your individual plan.  HMO patients will not be reimbursed by IBC for these types of services.  Patients in this situation should expect to pay at least some of the costs for their visit at the time of service.  Academic Urology has always seen patients under these circumstances and we have been successful in working out reasonable payment arrangements.

Even though it appears unlikely that IBC will negotiate a new contract with Academic Urology by the November 30 deadline, we intend to continue working toward an agreement. Our patients are an important part of this effort. Hundreds of you have already contacted IBC to express your disappointment with IBC’s actions. Your voice remains the most important and effective tool we have to encourage IBC to negotiate a new contract—today and after November 30. Even though the deadline is only about a week away, there is still time to negotiate and there is still time for you to continue making your voice heard. Even if you have already done so, we hope you will take any or all of the action steps below:

Switch your health insurance: Academic Urology maintains contracts with most other health insurers in our region.  Ask your employer if changing your health insurance is an option for you.  You can find a list of other insurers with which we have contracts on our web site.

Contact IBC: Patients should email Dan Hilferty, IBC’s President and CEO, at This e-mail address is being protected from spambots. You need JavaScript enabled to view it. , and I. Steven Udvarhelyi, MD, IBC’s Executive VP for Health Services at This e-mail address is being protected from spambots. You need JavaScript enabled to view it. . You can also write to both Mr. Hilferty and Dr. Udvarhelyi at Independence Blue Cross, 1901 Market Street, Philadelphia, PA 19103. Please send a copy of any email to IBC to This e-mail address is being protected from spambots. You need JavaScript enabled to view it. . Copies of paper correspondence can also be sent to Academic Urology at 211 South Gulph Road, King of Prussia, PA 19406.

Contact your elected leaders in Harrisburg: You can find contact information for your state representative and senator at www.legis.state.pa.us. Just look for “Who Is My Legislator?” and enter your address.  It is important for your elected officials to hear from you about IBC’s disruption of your physician relationship.

We do know what IBC agreed to pay us in our last contract, and our request for a new contract is based upon those rates that IBC has paid for the past four years. We also know that IBC has offered--without negotiation--a contract that would cut Academic Urology's reimbursements by 38 percent. We simply cannot accept a cut of this size and provide you the same quality care. It is interesting to note that Academic Urology has not faced these issues with any other commercial insurance company.

Since early September, when IBC first told you of its intention to drop Academic Urology, we have tried very hard to bring IBC to the negotiating table so we could work out our differences. Hundreds of patients have helped in this effort by contacting the insurer and their elected officials. Those patient voices did prompt IBC to relent and have a meeting, though it continues to maintain its "no negotiation" position.

While we are still hopeful that a new agreement can be reached, we must also be realistic and plan for the likelihood that Academic Urology will be considered “out of network” after the end of this month. Within the next week you will receive a letter from us outlining what we believe being “out of network” will mean for our IBC patients’ coverage. We encourage you to read this letter carefully and to check our website, www.academicurology.com, for updates.

Thank you again for your support. We deeply appreciate it.

David J. Ellis, MD, FACS

President
Academic Urology
 

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Updated November 15, 2011

Dear Patient:

As part of our efforts to bring IBC to the negotiating table, Academic Urology has been reaching out to our elected officials in both Harrisburg. We know many of you have also contacted your elected officials.

We are continuing to work hard on behalf of our patients who are IBC subscribers and are grateful for the support and encouragement that so many of you have shared with us. You can expect additional information from us as we approach the November 30 deadline for our contract. We also encourage you to visit our web site for updates.

Thank you again for your support.

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Updated October 6, 2011:

Dear Patient,  

By now you are probably aware that Independence Blue Cross (IBC) intends to end its contract with Academic Urology, effective November 30, 2011. Obviously, this is of great concern to us and to you. For those of you who have already contacted IBC to express your dissatisfaction with the insurer’s actions, we are deeply appreciative and grateful. Your voice is the only one that matters.

As of the writing of this letter, IBC continues to refuse to meet with Academic Urology to negotiate a new contract. IBC has demanded that Academic Urology accept a“take-it-or-leave-it” arrangement that our analysis indicates would reduce our reimbursement by 38 percent. A cut of this size would harm our ability to provide you—and all our patients—with the high quality urologic care you deserve and expect.

Here are some facts to keep in mind as we continue to work to resolve this issue:
 
Our first goal is to ensure that you can continue to see your Academic Urology physician and receive the best available urologic care. Even if IBC refuses to negotiate a new contract, you can continue to see and be treated by your Academic Urology physician now and after November 30. While care after that date could be considered “out of network,” it could be covered under the terms of your IBC plan. Each office will work with you to process any necessary paperwork or payment arrangements.

We want to reach a new agreement with IBC that provides our IBC-insured patients with uninterrupted access to high quality urologic care, just like all of our other patients. Academic Urology is seeking a two percent annual increase from the current contract that IBC accepted four years ago. Our request is below the rate of inflation for medical care.