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Mission’s pact with Blue Cross ends; now what?
Wednesday, 01 November 2017 21:54

From Staff Reports 

They really did it.

Industry analysts were not taking it too seriously. They had seen the bluff too many times before, and providers and insurers always came to a settlement by deadline.

But on Oct. 5, Mission Health really did allow its contract with Blue Cross Blue Shield North Carolina to expire. 

All Mission physicians and facilities are now officially out-of-network, not just for BCBSNC, but for all carriers of any Blue Cross Blue Shield plans from any other state.

Those needing to use emergency services will always be in-network at the nearest hospital. Other exceptions include persons with qualified conditions or qualified extenuating circumstances. Federal employees will be out-of-network on Nov. 16, and persons receiving physical therapy from CarePartners will be out-of-network on March 3, 2018.

People may continue to receive services out of network. They will just have to arrange other terms of payment, and it will likely be more expensive.

Mission is assisting people running into difficulty finding alternative coverage. The help-line phone number is 417-0480, and the website is MissionStandsWithYou.org.

Spokespersons for Mission said they could not negotiate with BCBSNC as long as the insurer insisted on what has been called “forever zero.” 

In spite of the hospital’s continued capital growth and expansion, Mission argues BCBSNC’s payments would not only freeze reimbursement rates for the foreseeable future, they would cap them at an unworkable level.

Mission spokespersons said they would have accepted no reimbursement increase for persons who purchased insurance on the Obamacare exchanges because those people had no other option; but when the contract fell through, that provision fell with it.

Meanwhile, BCBSNC officials called upon Mission Health on Oct. 12 to retract comments in a private email sent Oct. 4 to its roughly 60 senior leaders in early October by Ron Paulus, Mission’s president and chief executive officer.

Blue Cross said in a statement that the email “deepens our concerns and dampens our hope” that the sides can strike a deal.” The insurance provider argued that Paulus’ remarks, which were made the night before their deal expired, are “defamatory and inflammatory.”

Specifically, BCBSNC pointed to a comment by Paulus about the uncertainty of the future, but says he is at peace “whether tomorrow and the weeks to come turn out to be a bloody slaughter like storming the beaches of Normandy, or precision warfare like the first Persian Gulf War.”

BCBSNC’s statement noted, “As a starting point for breaching the divide, he (Paulus) appears intent on widening, we invite the CEO to retract statements he thought would remain private and then stand in stark contrast to what he says in public.” 

Paulus also called Blue Cross “the most unethical, bullying foe that I have ever faced.”

A Mission spokeswoman declined to comment on the Oct. 12 Blue Cross statement.

In turn, Paulus told local news media he would not comment further on the situation unless and until it is fully resolved.

Paulus said the matter is too serious to play games and raise false hopes. He encouraged people seeking medical attention from Mission to “immediately find other coverage.”

Paulus told the Asheville Citizen-Times that, “while I don’t have a crystal ball and will always hope for the best... I would imagine we will be in calendar 2018 prior to any agreement.”

In a news release sent out Oct. 5, Mission said the contract expired “without negotiations ever occurring because BCBSNC simply refused to speak with Mission Health about a new contract.”

Further, Mission’s news release noted, “Unfortunately, BCBSNC members who purchased health insurance coverage on the Affordable Care Act exchanges will also be out-of-network, though they should have not been impacted.

“That’s because Mission Health offered to accept BCBSNC’s demand for no payment increase for those individuals given the lack of alternative market options available. Shockingly, BCBSNC refused to accept Mission’s offer unless we also accepted a ‘forever zero’ contract across all lines of business.That rejection of its own demand by BCBSNC forces people who receive health insurance on the exchange to choose between accessing care out of network or avoiding needed care altogether.”

Meanwhile, BCBSNC has argued it was offering Mission the same deal it offered 40 other providers, all of whom accepted it. The insurer’s position is Mission was opposed to its requirement that patient outcomes be tied to reimbursement rates.

BCBSNC’s website indicated discussions are ongoing, but the insurer, too, will make an announcement only when the negotiations are concluded.

“Because provider contracts by all Blue Cross and Blue Shield plans apply to members of all other Blue Cross and/or Blue Shield plans, Blue Cross and Blue Shield members in other states are able to take advantage of Blue Cross NC’s network for in-network coverage,” BCBS spokesman Austin Vevurka recently noted:

“Likewise, a Blue Cross NC customer in South Carolina is able to take advantage of Blue Cross SC’s network for in-network coverage.  Thus, when a provider decides to terminate their contract and go out-of-network with one Blue Cross Blue Shield plan then they are also deciding to go out-of-network for all other Blue Cross Blue Shield plans.”

Park Ridge Health and Pardee Memorial Hospital remain in the BCBSNC network, as do various specialized offices, which may be located on a map at bcbsnc.com.

Hospitals affected include Angel Medical Center and Highlands Cashiers Hospital in Macon County, Blue Ridge Regional Medical Center in Mitchell County, Mission Hospital and CarePartners Rehab Hospital in Buncombe County, McDowell Hospital and Transylvania Community Hospital. 


 



 


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