The Washington PostDemocracy Dies in Darkness

Hopkins may leave CareFirst network, leaving patients in the lurch

Johns Hopkins Hospital is warning people with CareFirst BlueCross BlueShield that it may no longer accept their insurance starting as early as Dec. 5. (Rob Carr/Getty Images)

Johns Hopkins has warned nearly 300,000 patients that their doctors, nurses and other health care providers may no longer accept CareFirst BlueCross BlueShield health insurance as soon as Dec. 5, jeopardizing patients’ access to care.

Hopkins and CareFirst are at an impasse over rates the insurance company pays for care at Hopkins, a major provider of primary, specialized and outpatient surgical services in the region.

CareFirst officials accused Hopkins of putting “the people we collectively serve” in the middle of contract negotiations that began in June, an allegation denied by Kevin W. Sowers, president of the Johns Hopkins Health System and executive vice president of Johns Hopkins Medicine.

“This was a very difficult decision and was not a mechanism to put patients in the middle,” Sowers said. “We did not take this decision lightly.”

The health care system is contractually obligated to give 90 days notice before providers leave the network, he said. Weekly talks continue over the contract, which covers about 4,000 providers employed by Hopkins at the Johns Hopkins flagship hospital and Bayview Medical Center in Baltimore, as well as Howard County General Hospital in Columbia, Md., Suburban Hospital in Bethesda and Sibley Memorial Hospital in Washington. Providers at stand-alone ambulatory surgery centers, including those in Bethesda and Columbia, would also be affected.

In addition to the providers, Hopkins hospitals in Maryland may leave the network as well, if Hopkins and CareFirst still can’t reach an agreement by March 5, meaning hospital stays would not be covered.

The changes would leave people like Deborah Wassertzug, a three-time cancer survivor who requires close monitoring from a team of experts, scrambling for a new insurance plan on short notice. As a freelance translator, she is enrolled in CareFirst through the Affordable Care Act.

“Having a specialist I can see who has seen a lot of patients like me is really important, so it’s not like I can pick up and move to another doctor,” she said.

Wassertzug, 50, was diagnosed with a melanoma in 2013 that later metastasized to her lungs and brain. She is in remission, but a cancer medication she was taking touched off recurrent inflammation of her retina and iris — complications that hampered her vision and required the care of a Hopkins ocular immunologist. That’s in addition to a gastroenterologist, rheumatologist and oncologist.

Her oncologist, who keeps once-a-week hours at Sibley not far from Wassertzug’s home in Rockville, specializes in melanoma, which requires scans as often as every four months and a special kind of blood test that acts as an early warning system for cancer recurrence.

“I think [for] anyone who has had cancer or is dealing with cancer, probably the worst thing they can hear is that there will be a disruption in their access to care or monitoring appointments,” she said. “You want things to stay on a normal trajectory. It can be pretty unsettling to have to change that.”

Sowers, the head of Hopkins, said the health system terminated its contract with CareFirst because the rates the insurance company reimburses Hopkins for providers’ services are 40 percent lower than other large companies, such as Cigna and Aetna — a disparity he called unsustainable.

“We felt we reached a point where we were so far apart that we really needed to give them that notice,” he said.

Insurer will pay $95 million, ending years-long legal fight over nonprofit’s surplus funds

The dispute comes just before the period when many patients choose their health insurance for the coming year, adding to the pressure for CareFirst. Hopkins and CareFirst are taking calls from concerned patients, and in addition to letters and emails, Hopkins produced a video featuring Sowers.

Hopkins and CareFirst officials said care could continue, even if no agreement is reached, for some people with severe illness, rare disorders or certain cancers, or for those who are enrolled in clinical trials.

“CareFirst has been strongly advocating for Johns Hopkins price increases to be reasonable in this negotiation, as any additional costs will add to the burden of employers and households who are already feeling strained in this uncertain economy,” officials said in a statement.

Steven Sacks, 72, a retired longtime Department of Energy employee enrolled in CareFirst in addition to Medicare, speculated that by terminating the contract pending final talks, Hopkins is pressuring CareFirst to act.

“They want to see who’s going to blink first,” he said.