Are you a health care worker? We’d love to hear from you. Email editor at northcarolinahealthnews.org
By Michael Gebelein
Now that Mission Health and Blue Cross Blue Shield of North Carolina have resolved a months-long contract dispute, public employees will soon be able to use their taxpayer-funded insurance plans at the region’s largest health care provider.
All state employees receive their health insurance benefits through Blue Cross, meaning that thousands of taxpayer-funded plans were effectively useless since Oct. 5 in parts of Western North Carolina where Mission Health is the dominant provider.
Mission and Blue Cross announced a new contract agreement on Dec. 5 in a joint statement, saying “both parties are pleased to reach agreement on the mutual goal of ensuring that the people of Western North Carolina receive the affordable, quality health care that they need.” The new agreement will take effect on Friday, Dec. 15.
Hundreds of thousands of Blue Cross customers were unable to use their insurance plans at Mission Health facilities when a contract between the hospital and the insurer expired in October, leading to several rounds of negotiations and both sides publicly trading barbs about which organizations was holding up a new agreement. Mission claimed that Blue Cross reimbursement rates were too low when coupled with rising health care costs as a whole.
Blue Cross pointed to service agreements it has with dozens of other hospitals across the state in an attempt to show that its policies weren’t out of line.
The termination of the contract meant that the insurer’s customers could still use Mission facilities, but their health care would be considered “out-of-network” and would cost much more than when the agreement was in place.
Despite the new contract, those Blue Cross customers who chose to continue visiting Mission facilities in the months when an agreement wasn’t in place will likely have to foot the bill for those services at the out-of-network rate.
“Services and care received between Oct. 5 and Dec. 15 will generally be processed as out-of-network, unless it is an emergency or approved through the Continuity of Care program,” Blue Cross spokesman Austin Vevurka said, in an email to CPP.
“In an emergency, Blue Cross NC customers should always go to the nearest hospital. Emergency care is always covered as an in-network benefit. Prior authorization is never required for emergency care. If an admission to the hospital is medically necessary after an emergency room visit at a Mission Health facility, we will process these benefits as in-network.”
The terms of the new contract, including the amount of time covered by the agreement, have not been disclosed by representatives of either party. Blue Cross said on its website that it can’t guarantee that a similar situation won’t arise in the future.
“It is unusual for a hospital to terminate a contract as it signals the end of negotiations,” the statement reads.
“While we cannot promise that a situation like this will not happen again, we can promise that we will continue to fight to make health care more affordable for our customers.”