Methodist Le Bonheur now out of network for Blue Cross TN patients

Tens of thousands of people, possibly more, in the Memphis area will be unable to access health care with Methodist providers or at a Methodist facility without a hefty out-of-pocket payment after contract negotiations failed between the health care system and Blue Cross Blue Shield of Tennessee.

After protracted negotiations, Methodist Le Bonheur Healthcare and Blue Cross failed to agree to terms before the expiration of their contract Dec. 31.

“Methodist Le Bonheur Healthcare negotiated in good faith, offering a number of concessions, including deep discounts on our current rates and to extend current contracts with BCBST to minimize any disruption in care for patients. Yet, BCBST continues to make unreasonable demands and refuses our offers,” Methodist said in a written statement.

Blue Cross said the contract negotiations broke down because the Methodist system is “being paid much higher rates than their peers,” something Methodist denies.

"Our Methodist Le Bonheur Healthcare system rates were significantly higher than our average rates for other facilities in the Memphis area – and in the case of Methodist Le Bonheur Children’s Hospital, their rates were the highest of any children’s hospital in Tennessee by far," Blue Cross said. "For the majority of these facilities, we offered Methodist Le Bonheur Healthcare new contracts with lower, fair-market rates that would enable us to lower premiums significantly for BlueCross members."

The estrangement between Methodist and Blue Cross will impact people whose employer-sponsored health insurance is through Blue Cross, including 14,000 covered by two City of Memphis plans, but also many covered by TennCare whose TennCare plans are administered by Blue Cross.

TennCare Select specifically covers children who are in foster care or have intellectual or developmental disabilities or disabilities qualifying them for supplemental security income.

As of November, 178,796 people in West Tennessee were covered by BlueCare, according to the state. Other insurance companies also partner with the state to administer coverage to other TennCare enrollees. It was not immediately clear how many of the 164,557 Shelby County children on the TennCare rolls would be impacted. Across the state, there were 53,732 individuals covered by TennCare Select as of November. It is not clear how many were in West Tennessee or Shelby County.

TennCare representatives have previously said that if a deal was not reached, the department would work to avoid a lapse in insurance.

Methodist has posted a list of frequently asked questions and answers for patients using Blue Cross Blue Shield at its website, www.methodisthealth.org/.

Blue Cross also has created a list of which networks and facilities are impacted at https://bcbstnetworkupdates.com/.

Reporter Corinne Kennedy contributed to this article.

Katherine Burgess covers county government and religion. She can be reached at katherine.burgess@commercialappeal.com or followed on Twitter @kathsburgess.

This article originally appeared on Memphis Commercial Appeal: Methodist Le Bonheur now out of network for Blue Cross TN patients