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Wednesday, 23 August 2017 13:45

Mission rolls out transition plan for BCBS patients

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Mission Health’s contract with Blue Cross Blue Shield North Carolina will expire Oct. 5, leaving thousands of patients to find another in-network provider or pay more out of pocket to see a Mission provider.

While Mission leaders are still hopeful a deal can be struck — even if it comes after the deadline — the nonprofit health care system has announced a plan to help patients through the transition. According to a press release from Mission, the transition plan will cover everyone with BCBSNC insurance coverage, including consumers with commercial insurance coverage and Medicare Advantage plans.

Mission CEO Dr. Ron Paulus has said Mission is willing to continue negotiations with BCBS even though Mission sent a letter to the insurance provider in early July saying its intent to terminate its contract in October. However, Paulus said BCBS wouldn’t even discuss the contract with Mission until after it expires on Oct. 5 per corporate policy.

The absence of Mission Health hospitals and physicians from BCBSNC’s network may have serious financial, logistical and clinical access impacts on consumers who need vital healthcare services. It will also affect the many self-insured employers who pay for their employees’ and dependents’ care expecting access to Mission providers.

“Now that we know BCBSNC’s final decision is to refuse to even speak with Mission, we are completing plans and associated logistics for this important transition,” said Paul McDowell, deputy chief financial officer for Mission Health. “Mission Health is committed to helping consumers through this difficult change to the degree humanly possible, and we will have the final details worked out in the next few weeks.”

State law prohibits BCBSNC from financially penalizing fully insured patients when a participating provider is not available without unreasonable delay. Because Mission is the only provider of certain services within the region, including but not limited to some heart surgical services, pediatric specialty services, certain high-risk maternity services and others, Mission will be assisting impacted patients to make full use of this important law’s consumer protections. Unfortunately, the law does not apply to consumers with self-funded employer coverage.

To reduce harm to consumers, Mission will provide a prompt payment discount to the balance of a patient’s bill after taking into account the patient’s personal financial responsibility. That discount will be applied when patients send their explanation of benefits (EOB) and any check received from BCBSNC to Mission Health within 10 days.

Paulus said this process is designed to manage the possibility of BCBC sending benefit payments directly to the patient rather than to Mission Health as the service provider. While that practice is already illegal in the majority of states in America, Paulus said it’s something that BCBSNC has routinely threatened to do.

“While we are helping employers through this transition, BCBSNC can help their customers by honoring each patient’s assignment of benefits election,” said McDowell. “There’s no reason whatsoever for BCBSNC to send checks to patients once Mission Health is out of network — other than trying to harm Mission and unduly worry consumers. Burdening sick or injured individuals and their families who are under duress with the myriad complexities of medical billing and asking them to sort through BCBSNC’s nearly impossible to understand reimbursement methods is simply wrong.”

Employers who provider BCBS insurance for their employees will have to decide whether to continue their plan with BCBS and lose in-network access or look for another provider that is still in-network. Mission recently renewed contracts with Cigna and Aetna and now offers its own employer group policies through Healthy State.

Mission Health will work collaboratively with any employer considering a switch from BCBSNC to another insurer to make the transition as easy and seamless as possible for them and for their employees.

“This is a sad situation. Not only do we wish this issue didn’t exist at all, we also wish it was simple; but it’s very complicated,” McDowell said. “Mission will do everything it can, within the boundaries of the law and an employer’s benefit plan, to ease this unnecessary transition burden on consumers.”

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