PROVIDENCE -- About 100 nurses, doctors and health care professionals from Landmark Medical Center descended on Blue Cross & Blue Shield of Rhode Island headquarters yesterday to draw attention to their claim that the health insurer had short-changed the Woonsocket-based hospital more than $4 million in reimbursements.

The peaceful, hour-long demonstration on the sidewalk at Empire and Westminster streets also sought to focus attention on Landmark's claim that Blue Cross has refused to adjust future reimbursement rates to more accurately reflect the hospital's costs of providing health-care services.

"We are here today to defend our community hospital and demand that Blue Cross Blue Shield deal with our hospital in a fair and reasonable manner," said Jan Peso, a registered nurse and president of the Northern Rhode Island United Nurses & Allied Professionals. "Landmark Medical Center has provided quality health care to our community for over 100 years. Woonsocket may not be the capital of Rhode Island and Landmark Medical Center may not be as big as some of the Providence hospitals, but we are just as important to the community that we serve."

Kim Keough, spokeswoman for Blue Cross, said she was "disappointed" that the pickets opted to protest outside the health insurer instead of returning to the bargaining table and negotiating future reimbursement rates. She also was insistent that Blue Cross does not owe Landmark millions of dollars.

"We do not owe them money," she said. "We are a company that keeps its word. If we owed them money, we would pay them."

This week, Richard P. Farias, executive vice president of Blue Cross & Blue Shield of Rhode Island, submitted an opinion piece to The Journal in which he dismissed Landmark's position that Blue Cross owes the hospital $4.2 million dating to 2002, and that Landmark is seeking an additional $4 million in reimbursements on top of established rates going forward.

Farias urged the hospital to resolve the issues "through fast-track binding arbitration." He wrote that Landmark has yet to respond to the offer.

At 4 p.m. yesterday, the former patients, doctors and nurses, some of whom wore green hospital scrubs, picketed in an orderly fashion outside Blue Cross headquarters. They draped banners on the building with messages such as, "Blue Cross Don't Be a Bully."

Edward J. Quinlan, president of the Hospital Association of Rhode Island, said that negotiations between hospitals and insurers are often intense and difficult -- but it's unusual for a hospital to go public with a contract dispute.

In recent years, Quinlan said, Blue Cross had made efforts to improve relations with providers.

"There's been a greater recognition by Blue Cross that providers needed to at least be reimbursed for their costs," he said. "The disagreement might be the speed with which that goal has been achieved."

Peso, the union president, said the reimubursement problems have placed Landmark's future at risk, especially after it recently launched a heart-surgery program and a cancer treatment unit on the hospital grounds. She said treatment for heart and cancer patients is costly and timely health-care reimbursement is essential.

"In order to keep these programs alive, we need reimbursement," she said.

Keough, of Blue Cross, said that Landmark is "trying to lay all of its financial problems at our feet." She also emphasized that Blue Cross patients amount to only one-third of Landmark's overall business.

Dr. Richard Ward, a member of the Landmark philanthropy foundation, joined the protestors yesterday to lend his support. Ward, a retired dentist from Cumberland, has undergone treatment for lymphoma and had a heart transplant in Boston. He said that the future of Landmark is important for a close-knit community such as Woonsocket. He said most city residents are dependent on the local hospital.

"The care they get there is all the care they are going to get," Ward said. "I want to try to make things better for the people in northern Rhode Island."

Journal Medical Writer Felice J. Freyer contributed to this report.

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