Thursday October 5th is the 'termination date' for the contract between Mission Health and Blue Cross Blue Shield North Carolina. If no agreement between the two is reached by then, customers of North Carolina's largest insurer will find themselves 'out of network' for non-emergency visits at facilities operated by Western North Carolina's largest healthcare provider. This would affect hundreds of thousands of people in the region, meaning they would either have to pay more for non-emergency visits, or switch insurers and/or doctors. There has been little movement between both sides since Mission announced it's termination intention on July 5th. Ever since, both sides have waged a protracted PR battle against one another. BCBSNC's vice president of network management Mark Werner sat down in studio with BPR's Matt Bush to discuss the latest. (BPR News has requested an interview with Mission Health for their side of this issue)
On whether any new negotiations have or will take place between both sides - "We've told Mission very clearly if they rescind and take back the termination notice, we will resume the negotiations immediately. Mission terminated us, and they can resolve this simply by rescinding that termination."
On what will happen to BCBSNC customers October 6th if no deal is reached - "For members of Blue Cross on October 6th they will be out of network (for non-emergency visits to Mission facilities). Three things can happen - one, they can switch to an in-network provider and they will have less out of pocket liability. Two, they could continue to seek care from Mission at out of network rates, which means they would pay more for their care. Third, in an emergency situation, they should go to the nearest hospital. If that is a Mission hospital, it will be covered at the full in-network rate."
On Mission's reason for terminating the contract - that reimbursements it receives from BCBSNC are not high enough and threaten Mission's ability to continue to offer care and keep healthcare costs down - "We are taking aggressive approach to control costs for our consumers. As we all know when watching the federal debate over the last five years with the implementation of the Affordable Care Act, health care is too expensive. Patients can't afford it, employers can't afford it, and many employers are dropping coverage because they simply can't afford it. We are looking to partner with hospitals across the state to help contain and control costs and slow down the cost curve. This has been something that has been embraced by many hospital (systems) across the state. Approximately 40 across the state have partnered with us to slow that cost curve. And we look forward to once we resume the negotiations with Mission to partner with them as well to control the cost curve." (Mission Health would be the only provider in North Carolina not in BCBSNC's network if no agreement is reached)
On how BCBSNC customers can find doctors in network that are not a part of Mission Health - "We have hundreds of physicians who do contract with us and other hospitals across the region where members can access care. There are certain 'continuity of care' services, where if patients have specific clinical conditions that warrant them to continue to receive care at Mission, we will make those appropriate administrative process changes for them. We encourage all members to contact our customer service number on the back (of their insurance card) to see if they qualify for one of those conditions.
On whether all BCBS customers would be affected or just BCBSNC customers - "It does cover all Blue Cross policies and all Blue Cross plans. That includes our Medicare Advantage plan called BlueMedicare. So the seniors in North Carolina who have Medicare Advantage would be out of network."
On why both sides can't get along and get this done - "We know this is a very anxious time for members. And that's why we are focusing on the consumer, on our customer, on helping them through this situation. What can be done? Mission terminated its contract back in July. With one phone call, with one letter to us, this can be resolved and we can get back to the table if Mission rescinds its letter of termination."
On why the letter of termination is so important - "One thing that we want to give to our employers, and our consumers, and our patients is stability. Knowing providers are in network, knowing they can go to a provider and be protected from skyrocketing costs. We can't give that certainty right now. We don't know if Mission is going to change its mind. That's why when one sides issues a notice of termination, we focus on protecting our consumers."
On whether the instability of the status of the Affordable Care Act and moves to repeal and/or change it in Congress has any affect on the Mission/BCBSNC standoff (BCBSNC is the lone insurer that offers coverage in Western North Carolina through the ACA healthcare exchange) - "I think what is going on with the ACA has put a lot of pressure on providers, on consumers, on payers. Unlike our competition we did not quit (offering coverage through the ACA exchange in North Carolina). We know that has brought great value to North Carolinians to have coverage. Without that, the uninsured really can't access quality healthcare. Over the past three years we've been in the exchange, at Mission alone, we have seen an additional $200-million in revenue that we have paid them for folks that were historically uninsured and who are now insured."