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Mission, Blue Cross restart negotiations
Tuesday, 05 December 2017 01:09

From Staff Reports 

Mission Health kept its promise in October to terminate its contract with Blue Cross and Blue Shield of North Carolina, if terms the hospital system deemed profitable could not be reached. 

Mission on July 5 had announced its intent to terminate the contract. Blue Cross then ended negotiations, stating it does not negotiate when a party opts out. The parties were unable to find an agreeable middle ground in the meantime.

The hospital system is also keeping its word about talking minimally to the press if negotiations resumed.

In November, both parties said the negotiations would begin again, but so as not to mislead members of the public with false rays of hope, neither would provide updates unless and until a contract was signed. Afterward, media outlets caught word that the two parties had resumed negotiations.

Previously, BCBSNC had explained it was corporate policy not to negotiate with parties who opt out of its contract, but now that Mission is an out-of-network party, talks could commence. 

Representatives from Mission said they were disappointed becauyse they had expected talks to resume immediately, instead of after a one-month delay.

 As of Oct. 5, those carrying Blue Cross insurance were considered out-of-network by all physicians and facilities affiliated with Mission Health. 

As a result, people seeking medical attention from local providers likely are paying more. However, emergency department visits and certain qualified expenses remain in-network. Those needing medical care are being encouraged to talk to Mission or BCBSNC for answers to specific questions.

 BCBSNC spokesperson Austin Vevurka said on Nov. 13 that “Blue Cross and Blue Shield of North Carolina and Mission Health have entered into discussions regarding a future network participation agreement, and will refrain from public comment until those talks are completed.”

Mission spokesperson Rowena Buffett Timms issued similar comments in mid-November, noting, “We have previously said that we were not going to comment, and we continue to refrain from comment.”

The two parties have clashed over rates. 

The agreement that was terminated Oct 5 set rates for how much Blue Cross paid Mission for caring for the 260,000 people in Western North Carolina that the insurer covers.

The termination of the contract means most people with BCBSNC insurance are having to pay more for services from Mission doctors, hospitals and other Mission health care facilities — or get care elsewhere.

Meanwhile, Blue Cross set up a website titled “Know the Facts About Mission Health’s Decision to Leave Blue Cross...” on Nov. 1. The aforementioned Blue Cross website states:

“Since Mission Health decided to remove its doctors and hospitals from our network, the system has been aggressive in blaming Blue Cross NC for the choice it made. Their latest tactic is to intentionally use misleading data to justify their demands for higher payments from our customer.

“Mission Health demanded increases in the fees we pay them. This makes premiums and out-of-pocket costs higher for our customers. We work hard to keep health care and health insurance costs as low as possible, and most of the hospitals in our state share this goal. We’re disappointed Mission is canceling their contract instead of working with us to keep things as affordable as possible for our customers. 

“As a result, Mission Health facilities are out-of-network. This includes hospitals, outpatient facilities, and most healthcare providers.

“Mission Health is the only North Carolina health system leaving the Blue Cross NC network. Here are some things you need to know about this change.”

The web posting also addressed the following points in answer to what it termed frequently asked questions about Mission Health:

• “It was Mission Health’s decision.

• “Mission Health refuses to slow the increase of health care costs

• “Higher fees for Mission Health mean higher costs for custiomers.

• “Blue Cross customers should not have to pad Mission Health’s margins.

• “Some Blue Cross NC customers will still be able to use Mission Health facilities.”

To that last point, the BCBSNC posting noted that “customers already in a treatment plan for certain conditions such as cancer treatment or maternity care at a Mission Health facility may be able to keep receiving treatments as part of our Continuity of Care program. (BCBSNC will work to identify members who may qualify for this program, and they will get a separate letter from us.)

“And emergency care is always covered as an in-network benefit. In the case of an emergency, Blue Cross NC customers should go to the nearest hospital. Prior authorization is never required for emergency care.”

Blue Cross NC provider information is available at bcbsnc.com/findadoctor.  For insurance information: www.bcbsnc.com/wnc or call (800) 446-8053.

Mission has set up the following website with information on the dispute: www.standwithmission.org.

For patient questions, Mission has asked to be called at 417-0480.


 



 


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