- After more than a year of attempting to reach agreement with Wayne Memorial Hospital to improve quality while reining in costs, negotiations have failed.
- The hospital insists on keeping contract provisions that allow it to unilaterally raise rates for BCBSNC customers.
- As a result, rates for outpatient services have increased 121 percent over the last 10 years; these services now cost 85 percent more at Wayne Memorial than the statewide hospital average.
CHAPEL HILL, N.C. – Blue Cross and Blue Shield of North Carolina (BCBSNC) announced today that its contract with Wayne Memorial Hospital (WMH), which is located in Goldsboro N.C., will end. The hospital will become out of network for BCBSNC customers seeking non-emergency care as of Dec. 5, 2013. BCBSNC will work to ensure a smooth transition for BCBSNC customers in the Wayne County area over the next several months. These contract changes do not affect Blue MedicareSM/Medicare Advantage customers.
“In over a decade of BCBSNC contract negotiations across the state, hospitals have agreed that they will discuss price increases for our customers with us, as opposed to unilaterally increasing their prices,” explained Lisa Cade, BCBSNC Vice President of Network Management. “Wayne Memorial insists on retaining the right to increase our customers’ costs whenever they want. This is unacceptable.”
In recent years, other North Carolina hospitals have also collaborated with BCBSNC to include quality incentives to improve patient outcomes as part of their contracts with BCBSNC.
For years, Wayne Memorial Hospital has used contract provisions to unilaterally raise rates for BCBSNC customers without negotiation. As a result, Wayne Memorial Hospital’s costs are significantly higher than similar hospitals statewide:
- Outpatient services rates – which account for the bulk of Wayne Memorial’s billing – have increased 121 percent over the last 10 years and are 85 percent higher than the statewide average.
- In many instances, BCBSNC customers pay more than twice the statewide average for tests such as a standard EKG at Wayne Memorial.
- For the past two years, Wayne Memorial Hospital has not met the required quality standards to be considered Tier 1 for BCBSNC’s Blue SelectSM product, which tiers hospitals based on quality and cost. Consequently, Wayne Memorial is a Tier 2 quality Blue Select hospital based on the data and outcomes they supply to CMS.
What BCBSNC customers should know
In case of an emergency, BCBSNC customers should always go to the nearest hospital. Emergency care is always covered at the in-network benefit level, and prior authorization is never required.
WMH will still be an in-network hospital until Dec. 5, 2013. By ending Wayne Memorial Hospital’s contract, this means that as of Dec. 5, 2013, in-network coverage for care at the hospital will be limited to emergency care and care that is not reasonably available at other area hospitals for BCBSNC customers.
BCBSNC has contracts with all other hospitals in the region. There are 34 in-network hospitals within driving distance, and the five nearest hospitals are within an approximately 30-mile radius. BCBSNC will honor any authorizations for in-network services at Wayne Memorial Hospital made in advance of Dec. 5, 2013. The company is also prepared to work with physicians and customers to help them access services at other area in-network hospitals.
Most BCBSNC plans allow customers to receive benefits for services provided at an out-of-network facility. However, customers must typically pay higher out-of-pocket costs for out-of-network care, and customers are reimbursed directly by BCBSNC.
Customers currently receiving care at Wayne Memorial who meet certain guidelines may continue to receive care at Wayne Memorial for a specified period of time. BCBSNC will contact those customers in November.
No physician practices are affected by the termination. Additional information about alternative facilities and transition of care is available online at www.bcbsnc.com.
Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.74 million members, including approximately 1 million served on behalf of other Blue Plans. For generations, 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 was recognized as one of the World’s Most Ethical Companies by Ethisphere Institute in 2012 and 2013. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Visit BCBSNC online at bcbsnc.com. All other marks are the property of their respective owners.