Published: December 03, 2008 09:56 pm      

Blue Cross seeks hearing on cardiac care at local hospital

Blue Cross Blue Shield is asking the state Health Care Authority in Charleston to conduct a hearing before it rules on Raleigh General Hospital’s application to add interventional cardiac care to its list of medical treatments.

No hearing date has been set by the HCA on the insurance provider’s request for a hearing, its chief legal adviser, Marianne Kapinos, said Wednesday.

Normally, hearings are sought by competing medical providers as a challenge, but in this instance, Raleigh General says Blue Cross Blue Shield is merely seeking one to acquire information on rates that would be assessed patients.

Raleigh General filed its petition to add angioplasty service after the HCA revised its original language so that the “one-hour rule” was rewritten to mean the entire time a patient is initially seen, then transported, must be considered.

Under the first rule, patients who could be driven to Charleston Area Medical Center within an hour were restricted to treatment there.

At the behest of Gov. Joe Manchin, who found the wording ambiguous, the rule was clarified to mean that the clock starts ticking the moment a patient is seen by another hospital. That would keep Raleigh General in the ball game since it is impossible to begin treatment there and then ship a patient to Charleston, all within the one-hour frame.

Kapinos said Blue Cross Blue Shield, like any other entity seeking a hearing, wasn’t obligated to spell out its reason in a letter to the HCA. The letter was signed by a carrier official, Ed Hamilton, who was not reachable for comment.

“We really don’t know until we get to the hearing,” Kapinos said. “Sometimes they do that just to get additional information, although everything we have is public information. At this point, until we have a pre-hearing, we won’t really know why they are challenging it.”

While not commenting on possible reasons for the hearing request, Raleigh General CEO Karen Bowling told The Register-Herald she hopes Blue Cross Blue Shield will “work with us as we strive to improve the quality of life for the citizens of southern West Virginia” in providing angioplasty service.

Those services are “universally recognized as the gold standard of care,” she said.

“We have submitted what we believe is a clear, concise application that demonstrates the need for these life-saving services to be provided by Raleigh General Hospital,” she added.

— E-mail:

mannix@register-herald.com