A dispute between CommonSpirit Well being’s CHI Memorial Well being Care System and Blue Cross and Blue Protect Tennessee might go away at the very least 38,000 sufferers left to foot the invoice for providers on the Chattanooga, Tenn.-based supplier group.
The disagreement marks at the very least the third CommonSpirit Well being system-owned facility to publicly dispute a Blues contract to date this yr.
“Memorial has been a associate with Blue Cross for a few years, and we’re disenchanted, and fairly frankly, shocked to be at this level,” a BCBS Tennessee spokesperson wrote in an electronic mail.
The not-for-profit insurer and CHI Memorial have been negotiating a brand new settlement since late 2020 and, if they’re unable to finalize a brand new contract by Sept. 7, the well being system can be out-of-network for the payer’s 3.5 million members. CHI Memorial stated it is purpose is to achieve an settlement with BCBS Tennessee and that it has been negotiating “in good religion” with the insurer however stated it has been “unable to achieve settlement on truthful and equitable reimbursement phrases.”
“The COVID-19 pandemic has emphasised the actually important nature of top quality, native care,” a CHI Memorial spokesperson wrote in an electronic mail. “Now greater than ever, sufferers want entry to caregivers and providers they belief. Renewed contracts with BCBST will permit us to proceed confronting the pandemic, and preserve entry to important providers.”
The dispute represents at the very least the third disagreement between a Blues plan and CommonSpirit Well being supplier in 2021, and comes as some insurers accuse well being methods of utilizing their post-COVID-19 publicity glow to publicly stress insurers into price will increase.
Earlier this week, Anthem Blue Cross and CommonSpirit’s Dignity Well being reported that they might not comply with new contract phrases, eradicating the biggest hospital community in California from Anthem’s community as of July 16. The contract termination impacts greater than 1 million sufferers, Dignity stated.
In January, CommonSpirit Well being’s CHI St. Luke’s reported reaching a brand new contract settlement with Blue Cross and Blue Protect of Texas, ending a months-long disagreement that might have prevented 65,000 sufferers from accessing the Houston-based system’s services.
CommonSpirit Well being didn’t instantly reply to an interview request about what was driving its disagreements with Blue Cross and Blue Protect plans throughout the U.S. The Chicago-based supplier represents the biggest not-for-profit well being system within the U.S., made up of 140 hospitals 21 states. It was shaped in 2019 via the mix of Catholic Well being Initiatives (CHI) and Dignity Well being.
On the finish of its most up-to-date quarter ended March 31, CommonSpirit Well being reported $539 million in working revenue. However, its earnings have been buoyed via the $500 million sale of its Optum360 income cycle administration firm and federal stimulus grants. Excluding these objects, CommonSpirit misplaced $117 million on operations in the course of the quarter.