March 22, 2015
A change in the rankings of 18 hospitals by the state’s largest insurer, Blue Cross Blue Shield of Alabama, could result in higher out-of-pocket costs for patients across the state.
Blue Cross Blue Shield of Alabama introduced its hospital tiered network in 2006, which classified hospitals as Tier 1 or Tier 2 based on the quality and the value of care. Patients save money by using preferred Tier 1 hospitals, and pay more out-of-pocket for Tier 2 hospitals.
Blue Cross moved 18 hospitals to Tier 2, a change that becomes effective next month. Eight hospitals moved to Tier 1 from Tier 2 and will cost less starting in April.
Insurers across the country have similar programs, which are intended to steer patients to high-quality, low-cost hospitals. Blue Cross Blue Shield of Alabama employees evaluate hospitals based on cost, quality and patient experience. Many of the criteria come from the Centers for Medicare and Medicaid Services, which provides online hospital rankings.
Hospitals in the lower tier are still in the Blue Cross network, but patients pay more in co-pays and deductibles. A spokeswoman for Blue Cross could not provide an estimate of the difference in cost.