CHAPEL HILL, N.C. – Officials of Blue Cross and Blue Shield of North Carolina (BCBSNC) have rejected an ultimatum from the Moses Cone Health System for an immediate 18 percent fee increase and a more than 36 percent increase overall by July 2009.
With BCBSNC standing firm against the large fee increase demand, Moses Cone has walked away from discussions, canceling its contracts to serve as a network hospital provider for BCBSNC members, effective November 1, 2007. BCBSNC called for Moses Cone to drop its cancellation and return to negotiations for a reasonable agreement that would not place such a severe financial burden on patients.
BCBSNC projects that Moses Cone’s demand would increase members’ premiums in Guilford County by nearly an additional five percent in the next year alone and increase medical costs in the region by tens of millions of dollars. Under its contract with Moses Cone, BCBSNC increased the hospital system’s reimbursement last year, including a double-digit percentage jump for inpatient services. The health insurer offered additional increases during the negotiations that were rejected by Moses Cone.
“Moses Cone is disrupting patient care in its pursuit of unreasonable fees that would make health care far less affordable in Guilford County,” said Milo Brunick, BCBSNC vice president of Network Management. “Our members rely on us to protect them from unreasonable fee requests such as the one demanded by Moses Cone. We call on Moses Cone to put aside this contract cancellation and work toward a realistic agreement.”
For some common scans and diagnostic procedures, Moses Cone is demanding two to six times as much as the best rates BCBSNC members can get at other facilities in the community. For example, Moses Cone is asking three times as much for a CT scan of the brain as the best price at another provider. For a chest X-ray, it wants six times the best price at another facility.
Beginning on November 1, BCBSNC members’ in-network care at Moses Cone hospitals will be limited to emergency care. Members should work with their physicians to ensure they have appropriate authorization for any non-emergency care at Moses Cone after the cancellation takes effect.
BCBSNC always advises members to go to the nearest hospital in any emergency. After the cancellation date, members can still continue to use Moses Cone for emergency services without prior authorization and at in-network benefits.
BCBSNC networks continue to include all other major medical centers in the state. In the Triad, it has 11 hospitals in its networks within about 35 miles of Moses Cone’s main campus. Among those hospitals are High Point Regional Hospital, N.C. Baptist Hospital, and Forsyth Medical Center. The company also has contracts with UNC Hospitals and Duke University Medical Center.
Moses Cone’s contract cancellation affects Moses H. Cone Memorial Hospital, Wesley Long Community Hospital, the Women’s Hospital of Greensboro and Annie Penn Hospital in Reidsville. The contracts involve members in BCBSNC’s commercial products (Blue Care®, Blue Options(SM), Blue Options HRA, Blue Options HSA, and Blue Advantage) and the Blue Cross and Blue Shield Federal Employee Program. State Health Plan members enrolled in the Blue Options PPO plans are also affected.
After the cancellation date, members will be able to receive in-network benefits for a certain period of time in some circumstances at Moses Cone for acute, chronic or terminal conditions that require continuing acute hospital care, with advance approval from BCBSNC. Members whose plans pay for out-of-network care will be able to receive covered services at Moses Cone after the cancellation date but will experience higher out-of-pocket costs because the hospital will no longer be in our networks.
About Blue Cross and Blue Shield of North Carolina:
Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.5 million members, including approximately 820,000 served on behalf of other Blue Plans. For 74 years, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Access BCBSNC online at www.bcbsnc.com.