The questions and emotions were plentiful at a Blue Cross Blue Shield of Nebraska town hall meeting about negotiations with Catholic Health Initiatives.
It was standing room only in a meeting room at the Midtown Holiday Inn Wednesday evening as people packed in to listen to a presentation by BCBS officials and ask questions about how the negotiations will affect them directly.
Lee Handke and Pat Bourne, both senior vice presidents for BCBS, gave presentations and answered questions. Since issuing a notice of termination to Denver-based Catholic Health Initiatives in April, BCBS executives have been working on a new contract with the organization. The issue began over the cost of care in the Omaha market. The cost of health care in Omaha, particularly at Alegent Creighton Health, which is a CHI property, is much higher then in other parts of Nebraska, Handke said. Alegent Creighton Health charges 10 to 30 percent more for services similar to those offered in other markets in Nebraska, and BCBS executives are asking CHI to bring the costs in line with other providers, he said.
Hospitals outside of Omaha, including St. Francis Medical Center in Grand Island and Good Samaritan Hospital in Kearney, are being impacted because CHI has all of its Nebraska facilities under one contract. BCBS offered to contract directly with the facilities outside of Omaha but the company has been unwilling to negotiate under those terms, Handke said.
The current contract was signed in 2009 with incremental price increases each year. This created the wide gap in Omaha, he said. BCBS executives have attempted to focus on just Omaha but CHI wants an agreement for the entire network, he said.
“This is a significant issue,” he said.
The contract will end on Aug. 31, he said. As of Sept. 1, CHI facilities and providers will be considered out-of-network. BCBS members can chose to use a non-CHI provider or facility or they can continue using a CHI facility or provider at a higher cost, he said. He said he realizes there is only one hospital in Grand Island so going to another facility would mean traveling to another town.
“Our intent is to limit disruption,” he said. “We know there’s a lot of anxiety about this.”
Handke said there have been weekly meetings to try and work out a new contract but so far those negotiations have failed because the CHI proposals haven’t reduced costs in Omaha.
“This is your money,” Bourne said. “This is money out of your pockets and we don’t take that lightly. We take this very seriously.”
This issue doesn’t just affect BCBS of Nebraska, it may also affect BCBS coverage from other states that use the CHI networks, he said.
Due to the confusion about the negotiations and the questions about what a contract termination could mean for BCBS members, a website has been created at www.nebraskablue.com/update. Bourne said the site includes information about alternate providers. Some of the information will also be mailed out to consumers, he said.
Handke recommended calling BCBS to find out if a facility or a doctor is in-network or out-of-network because there has been some confusion among physicians. He also recommended discussing options with doctors when it comes to deciding where a planned procedure can be done. These negotiations don’t affect non-CHI facilities such as Mary Lanning Healthcare in Hastings, he said.
Retail pharmacies and prescription drug coverage aren’t impacted by these negotiations, nor is the Grand Island Surgery Center because it isn’t a CHI property, Bourne said. Anyone who is currently undergoing treatments for cancer, renal disease or dialysis, or HIV and AIDS can apply for continuity of care, he said. Continuity of care is also available to pregnant women who are beyond their first trimester or who are at high risk, and to anyone who is a recent bone marrow or organ transplant recipient, he said. This means those patients would be allowed to continue the care they are receiving as in-network patients, he said.
Emergency care is treated as in-network also. This includes ambulance rides and visits to the emergency room for emergency care only, he said. However, lab work and x-rays aren’t covered if they aren’t part of the emergency care, he said.
“We are trying to make this as painless as possible while recognizing that it’s not,” Bourne said. “The intent is to make this as easy as possible for you to get the care you need.”
Several people who asked questions were emotional, even angry, about the situation. Handke and Bourne said they planned to stay at the meeting until everyone felt their questions had been addressed.
One woman asked why CHI representatives hadn’t attended any of the BCBS town halls so they could hear directly from consumers. Some people in the audience asked if there was anything they, as BCBS consumers, could do to help with the negotiations. Handke said Uninet, which holds the CHI contract, has given out the phone number and email address of BCBS’ chief executive officer, which he didn’t think was productive. Instead of contacting CHI, Handke suggested speaking to doctors or hospital executives to share thoughts and concerns. The health care providers can then pass that information to CHI, he said.
“We have a positive relationship with CHI’s negotiation team,” Handke said. “We just have a difference of opinion.”
Date: August 13, 2014