Raleigh, N.C.-based WakeMed Health & Hospitals and Durham-based Blue Cross and Blue Shield of North Carolina reached a contract impasse that could leave some members unable to receive in-network care at WakeMed unless they enroll in a different plan this week, reports The News & Observer.
Affected members include BCBSNC's Blue Value plan policyholders. The plan — sold on and off the state's federal exchange — allows members to receive medical services from hospitals and physicians with Chapel Hill-based UNC Health Care and WakeMed's hospitals, clinics, labs and roughly 800 area physicians.
Donald Gintzig, CEO of WakeMed, said the system disagreed with BCBSNC over physician payments. According to the report, BCBSNC planned to cut reimbursement rates for WakeMed providers.
BCBSNC spokesperson Ryan Vulcan told The News & Observer in an emailed statement that "WakeMed chose to leave the Blue Value network because they are participating in our other narrow network product Blue Local with Duke Medicine and WakeMed."
Mr. Gintzig said if affected members enroll in BCBSNC Blue Local plan by Dec. 15, they can sustain in-network coverage with WakeMed providers next year.
BCBSNC provided the following statement:
- WakeMed has decided they will no longer accept discounted rates for our customers on Blue Value plans, and therefore will no longer participate in the Blue Value network starting on Jan. 1, 2017.
- Though WakeMed is not participating in the Blue Value network, customer benefits remain the same. Those enrolling in Blue Value will simply need to visit another hospital in the Blue Value network.
- Many doctors will remain in-network through Key Physicians on the Blue Value Plan. Most affected members will be able to keep their doctor.
- Some Blue Value customers will be able to visit WakeMed hospitals without paying higher out-of-network fees for a period of time. BCBSNC has proactively contacted these members, who may qualify for continuity of care.
- WakeMed remains in-network in our Blue Local, Blue Advantage, Blue Options, Federal Employee Plan, State Health Plan and Blue Medicare plans.
Correction: This article was updated on Dec. 15 at 9:04 a.m. to reflect that WakeMed will no longer participate in the Blue Value network effective Jan. 1., and to include a statement from BCBSNC. The previous article incorrectly stated a contract impasse between WakeMed and BCBSNC could leave several thousand people uninsured. We regret this error.