PITTSFIELD, Mass. — Berkshire Health Systems is taking exception to Boston Medical Center HealthNet's implication that the two sides failing to renew insurance coverage is the health system's fault.

 

"We have tried to take the high road here and focus on helping people get the coverage they need. We see that their spokespeople are trying to put the blame on us," said Senior Vice President Ruth Blodgett in an email on Friday.  

 

"For the record, the publicly available data about costs indicate that our inpatient costs are average for the state, and our physician costs are actually below average. And when you look at Total Medical Expense for the Berkshires, which reflects the total continuum of care and the broadest measure of cost and efficiency, we are better than average."

 

The BMC HealthNet program is a branch of insurance focused on providing Medicaid insurance coverage. In December, it ended coverage for patients with Baystate Health Systems and followed up this month with ending its relationship with Berkshire Health Systems.

 

Kevin Klein, BMC HealthNet's chief marketing and sales officer, said BHS did not renew at a lower reimbursement rate that HealthNet offered to match that of state reimbursements. 

 

"Berkshire Medical Center and Fairview Hospital are our highest-cost facilities in Western Massachusetts, and we have been losing money in the Berkshire service area for several years; this is not sustainable in the long term," Klein said on Wednesday. 

 

"We also pay Berkshire-owned doctors significantly more than the MassHealth fee schedule, though we did not request a change in these rates. As a result, we issued a letter of non-renewal to Berkshire with the intent of achieving rate alignment, and Berkshire indicated that they are not able to accept a rate reduction and have accepted the termination."

 

Klein said BMC HealthNet posted a $43.3 million operating loss in 2014 because of the gap between state reimbursements and what they had been giving the various health care providers.

 

BHS shot back saying it had previously accepted millions of dollars in reductions to help the insurance provider but couldn't accept any more loss of revenue.

 

"Last year, we accepted a reduction from BMC HealthNet of $3.5 million to help them be able to stay in the market. We did not feel we should or could jeopardize any more reduction for our community in order to help BMC Health Net or Boston Medical Center, their sponsor. Other organizations like Baystate have made similar decisions," Blodgett wrote.

 

The issue, according to BHS, lies more with the state than it does with the health care providers. Numerous other Medicaid health insurance providers across the state have also dealt with operating losses in recent years. Blodgett says the underfunding is causing issues between insurers and the state and has nothing to do with Berkshire Health Systems.

 

Meanwhile, BHS says there are a number of other MassHealth insurance providers in the area to service the approximately 12,000 people in the area using BMC HealthNet. 

 

"We also feel that our job here is to make sure people have access to appropriate MassHealth plans, and we do still have several good options available for our community. We have reached out to this patient population with a personalized letter and offered to help facilitate any transitions through our advocacy offices in Pittsfield and Great Barrington as well as EcuHealth in North County," Blodgett wrote.