With the contract between Memorial Health Care System and BlueCross BlueShield of Tennessee set to expire Tuesday, both sides seem to be communicating contradictory messages.
The insurer sent a letter to its users telling them not to be confused by Memorial’s pledge to waive out-of-network charges.
“Memorial’s decision to waive charges does not change their status as an out-of-network provider,” Henry Smith, senior vice president, operations and chief marketing officer, said in the letter. “That means if you receive out-of-network care at Memorial, your costs will be much higher.”
But Memorial’s Lisa McCluskey, marketing communications vice president, said the health care system has started a manual process to flag every BCBST member account for review, so they won't be charged more than usual.
“We have a sophisticated process to fact check the in-network rates and ensure each member will not be financially harmed through the process,” she said in an email. “Our goal is to protect the patient, and we hope that is BlueCross BlueShield’s goal as well.”
According to BCBST, Memorial doctors, the Chattanooga Heart Institute and Memorial Mission Surgery Center will remain in Network P.
The negotiations only impact care provided by Memorial Hospital, Memorial Hospital in Hixson and the MaryEllen Locher Breast Cancer Center.
Layoffs in the midst of negotiations
The companies have been negotiating for months, and leaders came to an impasse in recent weeks.
According to the Chattanooga Times Free Press, Memorial has brought in $190 million in profits in the past six years.
Memorial Health Care System President and CEO James M. Hobson said in a prepared statement last week that since the recession and the passage of the Affordable Care Act, the health care industry is undergoing a "transformational change."
He said those in the health care industry must change to respond to the "pressure of health care reform."
"Hospitals across the nation are faced with decreasing reimbursement from commercial payers, while the number of Medicare enrollees swells," he said. "At Memorial, we’ve implemented initiatives to sharpen our focus on the core competencies of the health system and achieve best in class in quality, cost and the patient experience."
Nooga.com has requested a phone interview with a Memorial leader about the layoffs.
Leaders with the health care system said last week that they wanted BCBST to extend the contract for 30 days, but the insurance company was unwilling to make that deal.
“Memorial’s request for a 30-day contract extension was linked to ever-increasing financial demands and other terms we cannot accept in the best interest of our members,” Roy Vaughn, vice president of corporate communications for BlueCross, said in a prepared statement.
Memorial leaders said last week that the last proposal—a long-term contract with annual rate adjustments well below BlueCross premium increases—is on the table for BlueCross to consider.
“We have left our last proposal on the table for BlueCross to consider at any time,” according to Memorial’s website. “It is important to know that BlueCross patients do not have to switch hospitals or find a new physician. This is true, no matter what BlueCross communicates.”
BCBST leaders said in a news release that the company is already paying Memorial competitive reimbursement rates and that Memorial is the most profitable hospital in the region, according to “third-party analysis.”
BCBST leaders said that analysis shows Memorial earns a 30 percent profit margin from the rates they currently pay.