Mission Health System Cancels Contract with Blue Cross NC; Withdraws from Network Effective October 5

Mission Health will be the only NC hospital system not in-network

Durham, NC – Mission Health System (Mission Health), which includes facilities and provider practices in Western North Carolina communities, notified Blue Cross and Blue Shield of North Carolina (Blue Cross NC) that it plans to leave the network effective Oct. 5, 2017. The health system has chosen to become the only system in North Carolina outside of Blue Cross NC’s network. All Mission Health hospitals, outpatient facilities and most physicians will be out of network beginning Oct. 5. Some Mission Health physicians within the health system will remain in network until March 2, 2018. Customers are encouraged to contact Mission Health to confirm when their doctor will be leaving the Blue Cross NC network.*

Mission Health’s decision means that most Blue Cross NC customers who receive care at a Mission Health facility, or from a Mission Health provider, will need to either seek care elsewhere, or could pay more out-of-pocket. Customers can always access emergency care as in-network care. Additionally, services qualifying for Blue Cross’s continuity of care program will be considered in-network.

“Rising medical costs are one of the most urgent issues facing North Carolina families. More than 43 other hospitals across the state have agreed to work with us to slow down unsustainable cost increases,” said Mark Werner, Vice President of Provider Network at Blue Cross NC.

“We are disappointed that Mission Health chose to cancel its contract with us rather than work toward a solution to keep health care and health insurance as affordable as possible for our customers in Western North Carolina.”

Blue Cross NC will work to ensure a smooth transition for customers in Western North Carolina over the next several months. These contract changes will also affect Blue MedicareSM/Medicare Advantage customers.

Blue Cross NC customers already pay more for care at Mission Health than at many other health systems. High costs directly contribute to higher premiums and out-of-pocket costs for our customers, and continued, significant price hikes are not sustainable.

Hospital costs for outpatient procedures and inpatient hospital stays account for nearly half of all medical costs for Blue Cross NC customers.[1] Mission Health is among the most expensive facilities for common inpatient procedures such as newborn deliveries, knee replacements as well as imaging procedures like chest x-rays and CT scans.[2]

What Happens After October 5?

Mission Health facilities and physicians remain in-network for Blue Cross NC customers through Oct. 4, 2017. After that date, in-network coverage for Blue Cross NC customers at Mission Health will be limited to emergency care, services that qualify for Blue Cross NC’s Continuity of Care program, and care that is not reasonably available at other area providers. Some Mission Health physicians within the health system will remain in-network until March 2, 2018.

In case of an emergency, Blue Cross NC customers should go to the nearest hospital. Emergency care is always covered as an in-network benefit. Prior authorization is never required for emergency care.

Most Blue Cross NC plans allow customers to receive covered services from out-of-network providers. However, customers typically must pay higher out-of-pocket costs for out-of-network care.

Blue Cross NC customers in the Western NC area seeking local, in-network hospital care should visit these surrounding hospitals:

  • LifePoint - Harris Regional Hospital                                                Sylva, Jackson County
  • LifePoint - Haywood Regional Medical Center                              Clyde, Haywood County
  • LifePoint - Frye Regional Hospital                                              Hickory, Catawba County
  • Catawba Valley Medical Center                                                  Hickory, Catawba County
  • Pardee Hospital                                                           Hendersonville, Henderson County
  • Park Ridge Health                                                        Hendersonville, Henderson County
  • Carolinas HealthCare System Blue Ridge-Morganton               Morganton, Burke County
  • Carolinas HealthCare System Blue Ridge-Valdese       Rutherford College, Burke County
  • Watauga Medical Center                                                              Boone, Watauga County

Customers can consider urgent, non-emergency care at in-network, urgent care locations. Blue Cross NC customers can find urgent care and primary care options in Buncombe and surrounding counties by visiting bcbsnc.com.   

Health care providers participating in Blue Cross NC’s networks are required to refer customers to other in-network providers. Blue Cross NC will honor authorizations for in-network services at Mission Health facilities and physician’s offices made in advance of Oct. 5. However, any services performed on or after Oct, 5 will be considered out-of-network. Through Blue Cross NC’s Continuity of Care program, we plan to contact customers who are pregnant, living with chronic illnesses and others who may qualify about how they can continue seeing their current doctors at Mission Health facilities or providers for a period of time without paying higher out-of-network fees.

Information about alternative facilities and transition of care is available online at www.bcbsnc.com. Blue Cross NC customers can contact the customer service number on their member ID cards for assistance or for more details about the Continuity of Care program. 

*Updated from original to reflect most recent information 

About Blue Cross and Blue Shield of North Carolina

Blue Cross and Blue Shield of North Carolina improves the health and well-being of our customers and communities by providing innovative health care products, services and information to more than 3.89 million members, including approximately 1 million served on behalf of other Blue Plans. Since 1933, we have worked to make North Carolina a better place to live through our support of community organizations, programs and events that promote good health. We have been recognized as one of the World’s Most Ethical Companies by Ethisphere Institute every year since 2012. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Visit Blue Cross NC online at bcbsnc.com. All other marks are the property of their respective owners.

 

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[1] Insured business only based on Business Segment Report and GAAP income statement, 2016. Excludes group self-funded (ASO) business

[2] Blue Cross NC Treatment Cost Estimator, Chest x-ray, CT Abdomen  Pelvis, Vaginal Delivery, Knee Replacement