As Blue Cross, Methodist negotiations continue, here's how it got to this point

After Blue Cross Blue Shield of Tennessee and Methodist Le Bonheur Healthcare failed to reach an agreement last year, Methodist facilities, including Le Bonheur Children's Hospital, became out of network for a significant number of Memphis-area residents.

While some insurance plans offer out-of-network benefits or reimbursement, seeing an out-of-network provider typically results in much higher costs for the patient for any visit or procedure.

Here’s a look at the timeline of the negotiations and where things stand.

City of Memphis employees to be impacted

With the clock ticking down in late November, the City of Memphis’ human resource department informed employees that failure to reach a deal in the next few weeks would impact them.

About 14,000 City of Memphis employees are covered by Blue Cross plans. The city’s human resource chief told employees if an agreement was not reached, the city would look to work out a continuity of care plan for those who had preplanned procedures.

Related: Playing with children's lives? Memphis families fed up with Methodist, Blue Cross fight

Local health care news: ‘The stars literally lined up.’ UTHSC opens new $45 million dental college facility

Congressman Steve Cohen urges state intervention

On Dec. 16, Rep. Steve Cohen sent a letter to Gov. Bill Lee, which was published online, asking him to help facilitate an agreement between the two entities. The congressman expressed particular concern for children with complex healthcare needs who need treatment at Le Bonheur.

Negotiations come down to the wire

As of Dec. 22, both Blue Cross and Methodist said negotiations were ongoing but there were some sticking points.

Blue Cross said the Methodist system charged higher rates than other facilities in the Memphis area and Le Bonheur, in particular, charged notably high rates.

Methodist, which has maintained its rates are fair and said it provides a significant level of free care locally, said Blue Cross asked the hospital system to slash rates by 40% and did not consider a counter-offer.

Tennessee health care: Federal HIV funding rerouted to nonprofits, bypasses Tennessee health department entirely

Methodist out of network

With no deal signed, Blue Cross Blue Shield of Tennessee members were now out-of-network at Methodist facilities as of Jan. 1. This applied to inpatient and outpatient care at Methodist facilities.

Partial agreement reached for TennCare recipients

On Feb. 8, Blue Cross and Methodist announced the parties had reached an agreement to keep Methodist in-network for TennCare recipients. The agreement, which took effect immediately, applied to those covered by BlueCare Tennessee, TennCare Select, CoverKids and BlueCare Plus, the Dual Special Needs Plan.

As of February, BlueCare served about 200,000 people in West Tennessee, according to Blue Cross.

Happy health care stories: Love seeing NICU babies dressed for holidays? Meet the woman who helps create the outfits

The latest on Methodist, Blue Cross Blue Shield negotiations

Negotiations have seemed to be at something of a standstill with a lack of public updates since early February. Both parties have said the other is the one that is not coming to the negotiating table in good faith. Methodist has now been out-of-network for Blue Cross members for more than five months.

As of May 16, Dalya Qualls White, senior vice president and chief communications officer at Blue Cross Blue Shield of Tennessee, said the two parties had exchanged proposals over the past two weeks and she was "optimistic we'll have an agreement soon."

Corinne S Kennedy covers health care, economic development and real estate for The Commercial Appeal. She can be reached via email at Corinne.Kennnedy@CommercialAppeal.com

This article originally appeared on Memphis Commercial Appeal: Blue Cross Blue Shield, Methodist Le Bonheur negotiations: The latest