Reductions key point in Mountain States negotiations with BlueCross

Sue Guinn Legg • Apr 6, 2013 at 8:44 AM

Contract negotiations between Mountain States Health Alliance and BlueCross BlueShield of Tennessee are within 60 days of a deadline for renewal that BlueCross says may result in the termination of its network coverage at MSHA facilities.

BCBS notified approximately 26,500 Blue Cross members this week that its coverage for care provided by MSHA facilities, including hospitals in Johnson City, Kingsport, Elizabethton and Mountain City, will end June 1.

Community relations representatives for BlueCross and Mountain States said Friday the sticking point is a proposed reduction in BlueCross reimbursements rates that both sides hope will be resolved without any interruption of coverage.

Mountain States contends the reduction is an unacceptable “double-digit” percentage that will move dollars used to improve health care in Northeast Tennessee “into the coffers of a commercial insurer.” Blue Cross counters the reduction is a single-digit percentage of the current reimbursement rate the company pays Mountain States and comparable to its reimbursement of other providers in the region and across the state.

“Unfortunately, we have not been able to reach an agreement on rates with Mountain States Health Alliance. They will leave Networks P and S June 1,” BlueCross Senior Vice President G. Henry Smith said in the letter mailed Wednesday to members in Mountain States’ Tennessee coverage area.

“When MSHA providers leave the network, you will not be able to get in-network care from them. ... You have a choice to go to any emergency room, hospital, doctor or other provider you choose. However ... if you choose to go to providers who are not in your network, you will pay them more for your care.”

Smith said Mountain States facilities to be impacted include Johnson City Medical Center, Franklin Woods Community Hospital, Sycamore Shoals Hospital, Johnson County Community Hospital, Indian Path Medical Center, Kingsport Ambulatory Surgery Center, Princeton Transitional Care, Indian Path Transitional Care, Medical Center Hospice, Medical Center Home Care, Johnson County Home Health, Mountain States Medical Group/ Blue Ridge Medical Management Corp., Mediserve Medical Equipment, Wilson Pharmacy Durable Medical Equipment and Wilson Pharmacy Home Infusion Therapy.

Tony Benton, vice president of communications for Mountain States, said the contract impacts only Blue Cross members in Tennessee and does not effect anyone insured by Blue Cross in other states or by BlueCare, TennCare, Medicaid or other government programs.

Mountain States has created a website at www.msha.com/   BCBSTN to keep patients insured by BlueCross informed during ongoing contract negotiations.

A notice posted at the website Friday states, “BlueCross has demanded significant cuts in reimbursements and we are negotiating with them in good faith to reach an agreement by the June 1 deadline.... We are doing everything in our power to ensure a continued relationship with BlueCross.”

The notice cites “catastrophic reimbursement cuts from the federal government” faced by health care providers in the region, including Medicare cuts of $503 million over the next 10 years to Mountain States alone.

“Given the already fragile state of our reimbursements, we cannot sustain significant cuts from commercial insurers, particularly when those cuts will be to the benefit of the insurance company and ultimately to the detriment of patient care in Northeast Tennessee. We do not believe that a reduction in our reimbursement will translate into lower costs for premiums.”

MSHA requests BlueCross members provide a copy of the notice to their employers and direct questions regarding the information to Marketing@msha.com  .

BlueCross is advising members in need of help finding a doctor, hospital or other provider in their network’s coverage to use the “Find a Doctor” tool on the company’s website at bcbst.com  ,or to call BCBS at 800-565-9140 or the number on the back of their member ID card.

Smith’s letter states, “BlueCross sees MSHA as a valued partner, and we want to keep them in our networks. We will continue working to reach an agreement, and we will let you know if that happens.”

Benton said, “First and foremost, we all want this to work out and we are still actively negotiating. ... Hopefully we’ll come to resolution pretty soon.”

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