Memorial, BlueCross Still At Odds; But Memorial Says Patients Won't Pay More

Wednesday, July 18, 2012

Facing an Aug. 1 contract deadline, Memorial Health Care System and BlueCross BlueShield of Tennessee are still at odds on a new contract. But, regardless of the outcome, Memorial CEO Jim Hobson said patients with BlueCross coverage won't have to pay more.

He said, "Because of our long-standing commitment to our patients and this community, we have put plans in place that allow BlueCross patients to continue their care with Memorial at no additional cost, regardless of the outcome of our negotiations.


"In a typical out of network situation, a hospital would collect additional money out of pocket from a patient because their health plan would pay the hospital less for providing care.  However, we are extending our discounted in-network rates should we become out of network on Aug. 1, 2012.  This means it will be the same as if we are in-network.  Nothing will change for BlueCross patients.  We are communicating this policy to BlueCross, so both organizations are on the same page."

He said under Tennessee law, BlueCross will grant certain patients in-network benefits after the Aug. 1, 2012 termination date under Continuity of Care provisions.  The following patients may qualify for Continuity of Care:

  • Inpatients
  • Pregnant women
  • Patients currently undergoing active treatment for an acute or chronic condition, such as chemotherapy.

Patients with these conditions should talk to their health care provider and contact BlueCross to determine if their care or procedure will continue to be covered after Aug. 1, it was stated.

Mr. Hobson said, "If you are a Blue Advantage (Medicare Advantage) Member with Blue Cross, your out of pocket costs, by law, will not be more than the amounts you would owe if we were in network, regardless of our potential out of network status on Aug. 1, 2012."

Memorial officials also said:

Emergency Care
Whatever the outcome and regardless of your benefit plan, patients can always receive emergency care through our emergency department.  This is a covered benefit in every health benefit plan whether we’re in-network or not.

Memorial Health Care Physicians
Please know that physicians are not impacted by our negotiations with BlueCross.  You can continue to see your Memorial Health Care physician just as you have in the past.

Out-of-State BlueCross Members
Every BlueCross state plan handles its members’ coverage in an out of network situation differently.  Some out-of-state BlueCross plans file claims through the BlueCross BlueShield of Tennessee office, in which case, your coverage may be affected by the negotiations.  This is not the case for every plan, so please call the BlueCross plan that administers your benefits directly to see how our negotiations with BlueCross may impact your access to Memorial Health Care System."

Mr. Hobson said, "We are making preparations to help patients navigate the issues associated with their care and what is covered or paid for by BlueCross.  We are putting the finishing touches on a BlueCross Transition Team, staffed by Memorial Health Care System team members who have been specially trained to help people through the process and ensure no interruption in care or difficulties with billing and payment. 

"Every situation will have its unique circumstances, and we will work one-on-one with everyone who needs help.  Please call us at 866-728-1993 if you have questions."

Memorial is asking those to send emails "if you support Memorial in our efforts to reach a fair agreement with BlueCross."

Memorial gave this assessment of the negotiations:

  • BlueCross has not agreed to fair rate increases to keep up with the cost of delivering the quality care that patients expect from Memorial. 
  • Memorial represents the best in clinical care, customer service and patient satisfaction, its total costs are competitive, and it’s the market leader in value, yet its payments from BlueCross are significantly below the market.
  • We have asked BlueCross for a onetime adjustment that brings Memorial closer to, although still below, market parity.  Beyond that, we’ve only asked for rate adjustments that keep pace with medical inflation – nothing more.
  • In our most recent conversations, we offered to take the one-time adjustment we need and spread it out over multiple years, with only single digit adjustments every year.  This would bring us very close to market rates by the end of the contract. 
  • BlueCross’ most recent offer was significantly below what our competitors are paid, yet our quality scores are among the best in the region.  
  • Both parties will be using a third party to validate the results in each of our proposals as an important first step in our negotiations, and we are confident BlueCross will see the facts of the situation and we can move forward together.



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