On MetroNews TalkLine, Jim Kaufman, President and CEO of the West Virginia Hospitals Association, said Wheeling Hospital will no longer accept West Virginia Public Employees Insurance (PEIA).
PEIA provides insurance to public school teachers and staff, state employees and other public employees in West Virginia.
Kaufman said Wheeling Hospital will stop accepting patients with PEIA on July 1st.
Wheeling Hospital will still accept Emergency Room PEIA patients after July 1st.
Kaufman says Wheeling Hospital is the first hospital to stop accepting PEIA patients but other hospitals have discussed getting rid of PEIA but no decisions have been made.
Kaufman also said Wheeling Hospital is struggling financially from below cost-of-service reimbursements and cutting PEIA patients would help financially.
A WVU Medicine spokesperson released the following statement:
Our mission is to provide excellent healthcare. Health insurance companies like PEIA however must be good partners by supporting their members – our patients – by adequately reimbursing their hospitals and caregivers. That’s not the case with PEIA. During a recent public session, PEIA reported that in 2020, it paid $47.8 million to out-of-state hospitals for just 1,903 inpatient visits while paying West Virginia hospitals $42 million for 11,576 visits. The following year, PEIA paid out-of-state hospitals $57.6 million for 2,195 inpatient visits and West Virginia hospitals $56.3 million for 12,313 visits. PEIA’s average payment for inpatient services to out-of-state hospitals in 2020 was nearly 600% higher than what PEIA paid to West Virginia hospitals. In 2021, the average was nearly 475% higher.
PEIA’s practice of underpaying West Virginia hospitals and not covering their actual costs has had an especially hard impact on Wheeling Hospital, which has lost $56 million over the past 3 years. While we had outlined our concerns to PEIA on this topic several months ago, no changes have been made. Nonetheless, we remain committed to working with PEIA to change how it reimburses West Virginia’s hospitals. The WVU Health System is making big investments in Wheeling to expand access and services, but Wheeling Hospital must be financially viable to achieve what we want to do there.WVU Medicine