Mission Health now out of network with Blue Cross and Blue Shield of NC

October 10, 2017


Effective today, October 5, 2017, Mission Health’s contract with Blue Cross has expired and essentially all Mission Health physicians and facilities are now out-of-network providers with Blue Cross and Blue Shield of North Carolina (BCBSNC).

Sadly, our contract expired without negotiations ever occurring because BCBSNC simply refused to speak with Mission Health about a new contract.  Important exceptions to Mission Health being out of network include:

  • Emergency care, which always remains in network regardless of our network status with BCBSNC;
  • Blue Cross Federal employees who will remain in network until November 16th;
  • Care for patients with certain conditions who qualify for Continuity of Care;
  • Care for patients whose care would otherwise be unduly delayed because of a lack of access to physicians or facilities without Mission Health;
  • CarePartners physical therapy services, which go out of network on March 3, 2018;
  • Services related to Blue Cross Medicare Supplement health plans.

Unfortunately, BCBSNC members who purchased health insurance coverage on the Affordable Care Act exchanges will also be out of network, though they should have not been impacted.  That’s because Mission Health offered to accept BCBSNC’s demand for no payment increase for those individuals given the lack of alternative market options available. Shockingly, BCBSNC refused to accept Mission’s offer unless we also accepted a “forever zero” contract across all lines of business.  That rejection of its own demand by BCBSNC forces people who receive health insurance on the Exchange to choose between accessing care out of network or avoiding needed care altogether.

“It is important that everyone is aware that you can keep your doctor and you can always choose Mission Health,” said Paulus. “Although your health benefits may have changed, remember, emergency care is ALWAYS in network, you can visit a doctor online at Mission-health.org/get-care.phpregardless of your insurance for $25 from 7:00 a.m. to 10:00 p.m. daily, you can communicate with your doctor through the patient portalat http://www.mission-health.org/connect-concierge.phpfor no fee and you can visit your doctor as an out-of-network provider taking into account our generous charity care and discount plans.”

“Now that Mission Health is out of network with BCBSNC, we will not make any further public comment about the contract situation under any circumstances until such time—if ever—that it is fully resolved,” said Ronald A. Paulus, MD, President and CEO of Mission Health. “The approach, content and pattern of communication from BCBSNC over the last four months has created a high likelihood of a circumstance where people could be misled by statements like ‘we’re close,’ even if we aren’t even speaking.  Should a contract ever be reached between Mission and BCBSNC, we will announce it immediately. Until then, Mission’s focus is exclusively on helping people who need care and people who are evaluating alternative health insurance options in the marketplace. Any BCBSNC employers or Medicare Advantage members in western North Carolina who want in-network access to Mission providers should immediately find other coverage.”

In addition to repeatedly attempting to negotiate for the last eight months, Mission Health has left the door open for three offers of compromise to BCBSNC:

  1. BCBSNC could accept the fair and reasonable offer that Mission Health made back in June.
  2. Mission Health could accept BCBSNC’s demands for a “one year, zero rate increase pause” as part of a long-term contract that also ensures Mission’s long-term stability. This would be contingent upon BCBSNC having an “increase pause” for its customers.
  3. Most practically, BCBSNC and Mission Health could ignore the past, start anew and negotiate an agreement that ensures high quality, affordable and effective care for the one million people who count on both organizations.

Emergency care and some specialty services will remain in network as required by law. For many of our patients, Mission providers are the only reasonable choice due to the patient’s condition. Mission will assist those patients to use the legal protections available to them if BCBSNC refuses to follow state and federal law. Patients with questions should call the dedicated information line at (828) 417-0480 or visit MissionStandsWithYou.org.

Patients with ongoing special conditions, including acute illness, chronic illness, pregnancy or a terminal illness insured by BCBSNC may continue receiving care from an out-of-network provider through Continuity of Care. Patients can learn more about who may qualify and how to apply by visiting MissionStandsWithYou.org.

AVAILABLE RESOURCES:

Using Mission Health Physicians.

·      Physician visits available online at Mission-health.org/get-care.php.

·      Mission Health patient portal at Mission-health.org/connect-concierge.php.

Questions about Continuity of Care.

  • Call (828) 412-6363 Monday through Friday from 8:00 a.m. to 8:00 p.m.
  • In-person visits at the Mission Health Cancer Center, room 115, Monday through Friday from 8:00 a.m. to 5:00 p.m.
  • Apply for Continuity of Care at StandWithMission.org/Resources.

Questions about other insurance plans.

  • If you are part of an employer-sponsored health plan, ask your employer to “tell BCBSNC to add Mission Health back to its network” or offer a second insurance option.
  • If you are an employer and sponsor a health plan, there are many other options. Mission Health will be in network with over 20 other plans available at MissionStandsWithYou.org.
  • If you have a Medicare Advantage health plan, open enrollment is October 15 through December 7, 2017, and a list of in-network plans is available at MissionStandsWithYou.org.

Still confused?

You are not alone; Call (828) 417-0480 and a Mission Health representative will return your call and answer your questions.

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