Blue Cross, Methodist reach agreement for TennCare patients
Amid ongoing gridlock, Blue Cross Blue Shield of Tennessee and the Methodist Le Bonheur Healthcare system have come to an agreement about providing in-network care for TennCare recipients, according to the insurer.
Recipients of TennCare plans administered by Blue Cross are again able to seek care at Methodist facilities, including Le Bonheur Children's Hospital, without hefty out-of-pocket payments. The insurance company said the agreement takes immediate effect. The agreement applies to people covered by BlueCare Tennessee, TennCare Select, CoverKids and BlueCare Plus, the Dual Special Needs Plan.
“We’re pleased to continue our vital and beneficial work alongside Methodist Le Bonheur Healthcare for the people of West Tennessee,” said Amber Cambron, president and CEO of BlueCare Tennessee. “This contract ensures that BlueCare members will be able to access health care, long-term support services, childhood wellness visits and more with support from the teams they trust.”
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“Providing the safest and highest quality care to our community, especially our most vulnerable patients, remains our top priority,” said Michael Ugwueke, president and CEO of Methodist Le Bonheur Healthcare. “This agreement, while a major step forward, represents a fraction of what we can accomplish when insurance companies put the interests of their patients first. We look forward to continued negotiations to return insurance coverage to all of the BCBST members we are so privileged to serve.”
Currently, BlueCare serves more than 630,000 members across the state, including about 200,000 people in West Tennessee, according to Blue Cross.
“We are grateful to our provider partners in the Memphis area who delivered vital support for BlueCare members while we worked to reach agreement,” said Cambron.
In a statement, Methodist said Blue Cross' "claims of relying on other facilities for care are not working. This is one of the reasons we pushed for this agreement with TennCare and BlueCare, to help alleviate the burden on those we serve."
How we got here
While this agreement impacts thousands, negotiations are ongoing about in-network coverage for others who have health insurance through Blue Cross Blue Shield of Tennessee. That includes 14,000 employees covered by two City of Memphis plans.
Those patients all fell out of network Jan. 1, when the healthcare system and the insurance company failed to come to an agreement on the rates Methodist charges and the fees Blue Cross pays, both for inpatient and outpatient care.
While they can still seek care at Methodist facilities, out-of-network patients often have to make significant out-of-pocket payments to do so. 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 everything from a standard checkup to an emergency room visit.
Negotiations over rates have been happening for months. Blue Cross said Methodist, and Le Bonheur in particular, charges significantly higher rates than other facilities in the area. Methodist said Blue Cross asked it to slash rates by 40% and did not consider a counter-offer. The hospital system has maintained its rates are fair.
Both parties said they're continuing to look for resolutions for ongoing disagreements.
Corinne S Kennedy covers healthcare, economic development and real estate for The Commercial Appeal. She can be reached via email at Corinne.Kennedy@CommercialAppeal.com
This article originally appeared on Memphis Commercial Appeal: Blue Cross Blue Shield, Methodist reach agreement on TennCare patients
