Here are five things to know.
1. Last month, Mission Health said it plans to leave BCBSNC’s network by Oct. 5. Mission Health board members wrote in a July 24 op-ed the system requested a “modest, mid-single digit reimbursement increase,” but BCBSNC denied the ask, “forcing a ‘forever zero’ contract.” BCBSNC refuted Mission Health’s requested fee hikes, stating the system “is among the most expensive facilities for common inpatient procedures.”
2. While a contract lapse between the organizations would affect all BCBSNC policyholders — including members with employer-based, Medicare Advantage and exchange plans — Mission Health said Thursday it would honor current payment rates for only BCBSNC customers purchasing coverage through the state’s ACA marketplace for 2018, or until an agreement is inked for all BCBSNC members. Mission’s proposed exemption “excludes those on the exchange from being impacted by BCBSNC’s unwillingness to even speak with us about a contract critical to Mission Health’s long run survival.”
3. Mission Health said it extended the offer because BCBSNC is the only payer participating on the exchange in western North Carolina. Roughly 50,000 individuals in western North Carolina purchase plans through the individual marketplace, Citizen-Times reports.
4. However, BCBSNC denied the exemption later Thursday. In a statement obtained by Mountain Xpress, the payer said Mission Health’s proposal “attempts to partially rescind their termination of our contracts. We were disappointed when Mission Health decided to unilaterally terminate those contracts last month. With today’s proposal, Mission Health continues to turn its back on senior citizens, state and county employees, businesses and taxpayers across western North Carolina. This is unfair to tens of thousands of other members; therefore Blue Cross NC has no choice but to reject this offer.”
5. BCBSNC added it remains “ready and willing to negotiate on behalf of ALL of our western North Carolina members as soon as Mission Health fully withdraws its termination.”
More articles on payer issues:
10 Medicare Advantage plans ranked by member satisfaction
UnitedHealth adds former GlaxoSmithKline CEO, medical school president to board
ACA’s insurance tax will increase premiums 2.6% in 2018, UnitedHealth-commissioned study finds
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.