Is Blue Cross Blue Shield your health plan? Dignity Health providers are no longer in your network

Dignity Health is no longer considered in-network for many metro Phoenix residents who have health insurance coverage through Blue Cross Blue Shield, which means some patients will need to find new providers at a time when the state is grappling with a primary care provider shortage.

Contract disputes between health providers and insurance companies are commonplace, but an agreement often is reached at the 11th hour, before the contract expires and patients are directly affected. That was the case with recent disputes between Phoenix Children's Hospital and Aetna, and Blue Cross Blue Shield and Southwest Medical Imaging.

But there was no last-minute agreement reached in the Dignity Health contract with Blue Cross Blue Shield of Arizona, and it could affect thousands of people.

The contract ended Feb. 1, which means some people with Dignity Health providers and Blue Cross Blue Shield health insurance are going to need to find care elsewhere or face prohibitive out-of-network health expenses.

Dignity Health is a major health provider in the Valley, and among its facilities are Dignity Health St. Joseph's Hospital and Medical Center in Phoenix, including its world-renowned Barrow Neurological Institute. The lack of a contract likely affects the health care of thousands of Arizona residents.

"We do not underestimate our responsibility as one of the region’s highest-quality health care organizations providing life-saving care today and in the future," Dignity Health said in a written statement. "Patients are at the center of everything we do, and we recognize the inconvenience this situation creates."

Yavapai Regional Medical Center and the patients who use it will not be affected by the contract problem, Dignity officials said.

Here's what we know so far about the failed contract.

Blue Cross Blue Shield says it has notified 16K members who had claims with Dignity Health during the past year

A lack of a contract affects most but not all Maricopa County and Pinal County residents with Blue Cross Blue Shield coverage. Anyone with Blue Cross Blue Shield coverage through the Federal Employee Program, Medicare Advantage, or individual and family Affordable Care Act (Obamacare) Plans is not affected, officials said.

The lack of a contract affects more than just people with Blue Cross Blue Shield of Arizona. It can impact people seeking care at Dignity Health with out-of-state Blue Cross Blue Shield plans, too, such as Blue Cross Blue Shield of Texas.

"We communicate changes with other plans and the same protections for continuity of care and access to emergency care apply," Blue Cross Blue Shield of Arizona said in a written statement.

Affected patients may make a 'continuity of care request' to keep their Dignity Health providers

The form can be found online by visiting www.azblue.com/provider/resources/forms and selecting Care Management Referral Form.

"For members who are in the course of care at Dignity, they can continue their care," Blue Cross Blue Shield of Arizona officials said in another written statement. "We have care teams ready to help, including our clinical rapid response team. ... We are standing by to make certain that all members will get the care they need."

Members may also reach out to service 24/7 at MemberHelp@azblue.com.

Renee Hunt, staff vice president of brand and reputation management for Blue Cross Blue Shield of Arizona said anyone with Blue Cross Blue Shield who has surgeries and procedures already scheduled may complete the service and any follow-up care and if members are "inappropriately turned away, we will work to intervene and correct."

"Dignity Health providers are obligated to continue care for members who are already scheduled for surgery or are in a course of treatment for certain conditions at the in-network level," she wrote in an emailed statement. "If members are not sure about whether you have continuity of care rights, we have teams standing by to help, please reach out."

Emergency room care will continue to be in network and is not affected

"For our general member population, if they need emergency care, they have access to all area hospitals, including Dignity, at the in-network level," a statement from Blue Cross Blue Shield of Arizona said.

Dignity Health blames Blue Cross Blue Shield of Arizona

Officials with Dignity Health say that "despite our best efforts" Blue Cross Blue Shield of Arizona "is unwilling to accept fair contract terms." In a statement provided to The Arizona Republic, Dignity Health goes on to say it was never the intent to leave the Blue Cross Blue Shield of Arizona network.

"We submitted several proposals to BCBSAZ and they rejected each one. We also offered to extend the negotiation period an additional two weeks in an attempt to avoid disruption for our patients, but BCBSAZ rejected our extension offer without providing a counter offer, causing the existing agreement to terminate," the statement says.

"To our great disappointment, BCBSAZ did not formally notify us of their decision to remove us from the network."

Dignity Health says Blue Cross Blue Shield is refusing to pay millions in claims

"We had hoped that BCBSAZ would work with us on collaborative solutions, but they have done the opposite," a Dignity Health statement says. "In fact, BCBSAZ has not even honored the terms of our existing contract: They are refusing to pay millions of dollars in outstanding claims for care our providers have already delivered, despite our repeated requests for relief."

Hunt, the Blue Cross Blue Shield of Arizona vice president, says the insurance company is not refusing to pay claims and that "despite the ongoing contract discussions, Dignity claims are being processed daily in the normal course of business."

Dignity Health hospitals send the Arizona insurer, often known as AZ Blue, claims that amount to about $100 million in billed charges each month, Hunt wrote in an emailed statement.

"Claims are received and processed daily, and we work closely with our providers to ensure that billing is appropriate, and claims are accurately paid," Hunt wrote. "As of January 31, we have claims that amount to about $102 million in billed charges from Dignity, which is consistent with what we would expect. ... To add perspective, AZ Blue receives and processes $8 billion in billed charges each year for hospitals."

Blue Cross Blue Shield of Arizona officials say they are 'standing up for affordability'

"We are most concerned that profitable hospitals are making care more expensive for Arizona families," Blue Cross Blue Shield of Arizona said in a statement when asked about the contract ending.

Both Blue Cross Blue Shield of Arizona and Dignity Health have webpages dedicated to providing information about the contract problems.

The Blue Cross Blue Shield page says the health insurer "worked hard to keep Dignity Health in the AZ Blue network, but they repeatedly rejected AZ Blue’s many offers of fair and reasonable increases."

The webpage also says that it is part of Blue Cross Blue Shield's job to make sure unnecessary increases are kept in check and that Dignity is already reimbursed at the top of the Arizona market.

Dignity Health says 'conversations continue' with Blue Cross Blue Shield

"Although our contract with BCBSAZ has ended, we are continuing to work in the best interests of our patients in hopes of reaching a new agreement with BCBSAZ," Dignity Health said in a statement. "We encourage patients to visit keepdignityhealth.org to stay informed or call 877-264-3264 with questions about their coverage including continuity of care."

Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on X, formerly known as Twitter @stephanieinnes

This article originally appeared on Arizona Republic: Blue Cross Blue Shield and Dignity Health negotiations fail