Academic Urology's goal has always been, and remains, to reach a new contract with IBC that supports our ability to provide high quality care to IBC subscribers. Whether we can depends on IBC. The insurer made a single “take it or leave it” offer to Academic Urology that would not support the provision of quality care, and has so far refused to engage in meaningful negotiations. While we are currently out of network, Academic Urology remains open to negotiations with IBC on a new contract. It is not possible for us to put a time frame on when a new contract might be achieved. Patients should continue to contact IBC to encourage the insurer to sit down with Academic Urology.
Costs will depend on your individual medical needs. Depending on your individual IBC plan, some of your costs may be reimbursed by the insurer. Please check with IBC for details on your Out of Network coverage. In all cases, we will work with you to best meet your needs, whether with Academic Urology or with another urologic healthcare provider, or with another health insurance plan.
Can I still see my urologist?Yes. Regardless of the details of your individual IBC plan, you can always see your Academic Urology physician. We can help you with insurance company paperwork, and/or on arranging payment for services provided. Our first priority has always been, and remains, the well being of our patients. We will do whatever we can to get you the best care.
What does Out of Network status mean for IBC-insured patients?
Out of Network status will affect patients depending on the details of their 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. Patients should contact IBC to determine specific coverage levels for their individual plan. Ultimately, IBC has final authority on what it will or will not cover—it is not up to Academic Urology.
Can you summarize possible coverage options?
Below is a summary of information provided to us by IBC, as we understand it.
•Emergency Care provided in a hospital or in an Emergency Department will continue to be covered. Academic Urology will bill you and IBC will reimburse you directly according to its schedule. For patients with any of IBC’s Medicare-related plans, the insurer will reimburse Academic Urology directly.
• Patients in active treatment will need 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. Academic Urology has always seen patients under these circumstances and we have been successful in working out reasonable payment arrangements.
Are Academic and IBC negotiating a new contract?
Since August, Academic Urology has made repeated requests to IBC to sit down and negotiate a new contract. The insurer did meet with Academic Urology a few times, but has refused to actually negotiate a new contract. Academic Urology wants to negotiate a contract and wants to keep IBC in our network of insurers. We remain willing to reach a new agreement with IBC that protects our ability to provide high quality urologic care to patients.
What about IBC’s claim that it has offered Academic Urology a contract that is consistent with what it pays other urologists?We have no idea what IBC pays other urologists—the insurer considers that information confidential. We do know what IBC agreed to pay Academic Urology in our most recent contract over the last four years. We also know IBC’s offer would cut payments to Academic Urology by an estimated 38 percent. A cut of that size would harm our ability to provide patients with quality urologic care.
What about IBC’s claim that it is trying to hold down healthcare costs?
The issue of rising healthcare costs is very complex, and involves hospitals, insurers, doctors, technology, government regulation, pharmaceuticals, and lifestyle choices of Americans. Academic Urology’s request to IBC in a new contract is well below the rate of medical inflation, and will have no effect on overall healthcare costs.
What can Academic Urology patients with IBC coverage do?
Even though Academic Urology is Out of Network, IBC subscribers can still take action to encourage the insurer to reach a new agreement with Academic Urology:
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.
Contact the PA Department of Insurance: Patients can register complaints about health insurers by calling 1-877-881-6388 or visiting the Department web site at
www.insurance.pa.gov.
How can patients remain informed about this situation?
