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 one of the nation’s Top 15 Health System, Mission Health. As a result of BCBSNC’s decision to refuse to even speak about a new contract and oust Mission Health from its network, BCBSNC will likely pay a lower percentage of the out-of-network fees than they would pay for the same in-network services.
“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. 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. Particularly so because BCBSNC will not provide Mission with access to the customer and member agreements that specify covered benefits. 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.”
There are significant exceptions to the problems created by the expiration of Mission Health’s contract with BCBSNC. First, state law prohibits BCBSNC from financially penalizing fully-insured patients when a participating provider is not available without unreasonable delay. This prohibition is critically important for patients and is a legally significant issue. Because Mission is the only provider of certain services within the region – including but not limited to heart surgical services, pediatric specialty services, high risk maternity services and others - we will be assisting impacted patients to make full use of this important law’s consumer protections. Unfortunately, this state law does not apply to consumers with self-funded employer coverage.
Second, to reduce harm to consumers, Mission will provide a generous, 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. This process is designed to manage any circumstance where BCBSNC may send benefit payments directly to the patient rather than to Mission Health as the service provider. This practice, already illegal in the majority of states in America, is 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. What every employer and patient wants is for their insurance company to do what a patient has asked by making all payments exactly as they have elected.” Mission Health also encourages patients to demand in writing that BCBSNC honor their assignment of benefits election so that they are not unduly burdened when they are sick or injured and Mission Health can respond to any BCBSNC errors.
For All Employers
The most important factor for every employer to consider is whether they will stay with BCBSNC after October 5 and lose in-network access to Mission Health or whether they will evaluate other highly competitive health benefit options that include Mission Health. “The really great news for every employer in the region is that Mission Health’s new contracts with Aetna and Cigna provide previously unavailable, affordable choices in the region that keep Mission Health in network,” said McDowell. Further, 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 valued employees.
For Self-Insured Employers
Aetna, Cigna and Healthy State each offer new, previously unavailable and highly competitive alternatives to BCBSNC. This is important news in that the state law prohibiting BCBSNC from financially penalizing fully-insured patients when a participating provider is not available without unreasonable delay does not apply to self-insured plans. Any self-insured employer that intends to remain with BCBSNC will need to specifically direct BCBSNC to continue to pay benefits on its behalf as in-network if the employer desires to protect its employees during this transition time. A self-funded employer’s plan is its own – and not BCBSNC’s plan – so the employer controls what BCBSNC does on its behalf.
More details on all transition plans will be announced by Labor Day. For the latest updates and more information on what you can do, please visit StandWithMission.org.