The largest private health insurance company in the state will drop Nason Medical Centers and Medcare Urgent Care from its network later this year.
BlueCross BlueShield of South Carolina and BlueChoice Health Plan customers can continue to see these providers after Oct. 8, but will become responsible for paying out-of-network costs.
"It's a strategic business decision," said Patti Embry-Tautenhan, a spokeswoman for the insurance company. "In the past 10 years, there has been a rapid expansion of the urgent care market in South Carolina, resulting in numerous providers in the market, resulting in duplicative services and so while we're removing some of the urgent care providers from the network, we still will continue to offer broad geographic choice and access for our members."
Nason Medical Center includes five Lowcountry locations. Medcare operates several clinics across the state, in Columbia, Anderson and Charleston.
Urgent care is considered one of health care's fastest-growing sectors, but experts acknowledge that the term is broad. Urgent care centers range from relatively small CVS Minute Clinics - meant primarily for flu shots, vaccinations and simple illnesses - to large medical centers staffed by physicians trained in emergency medicine.
While urgent care providers charge a fraction of the price for treatment compared with hospitals, some doctors and health care administrators believe that for-profit facilities, like Nason Medical Center and Medcare Urgent Care, notoriously overbill for unnecessary services to improve their margins and can be confusing for patients with life-threatening conditions who need immediate emergency room treatment.
The majority of BlueCross BlueShield and BlueChoice beneficiaries will no longer be able to see Nason Medical Center or Medcare providers in-network after Oct. 8, Embry-Tautenhan said, but there are exceptions.
Both companies will remain in-network for customers who purchased a plan through the Affordable Care Act marketplace, members with BlueChoice Medicaid plans, state health plan employees whose benefits are administered by BlueCross BlueShield of South Carolina, and seniors with BlueCare and BlueCross Medigap, Medicare supplement, Medicare Select and Medicare Advantage plans. Customers affected by the change will be notified, Embry-Tautenhan said.
In 2011, BlueCross BlueShield of South Carolina acquired a majority stake in UCI Medical Affiliates, which offers administrative support for Doctors Care, one of the largest networks of family medicine and urgent care centers in South Carolina and Tennessee.
Dr. Barron Nason, who co-founded Nason Medical Center in 2005, said the company is in "active discussions" with BlueCross BlueShield.
"Periodically we have to go through these contract negotiations," he said. "I'm confident we'll work through this."
He said Nason Medical Center treats many BlueCross BlueShield customers but did not know the percentage of patients covered by the company.
BlueCross BlueShield and BlueChoice notified Nason Medical Center in a June 6 letter that the company planned to drop the urgent care provider from its network later this year. Weeks earlier, The Post and Courier first reported that the government ordered the Nason Medical Center to discontinue its imaging services and to remove the word "emergency" from outside signs.
Another report outlined infighting among Nason Medical Center partners. One of its three owners alleged in court documents the company is insolvent and that its chief executive officer manipulated accounts to make the business appear more profitable than it actually is.
Nason said he's prohibited from discussing the ongoing legal issues.
Dr. Radwan Hallaba, who owns Medcare Urgent Care, was unable to provide a response Thursday afternoon.
Reach Lauren Sausser at 937-5598.
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