Frequently Asked Questions
Last Updated on January 24, 2024
CHI Memorial asked to end our contract early and demanded significant rate increases, despite having reached an agreement for higher rates in September 2021. Instead, we opted to keep our contract’s original timeline and negotiate a new contract in 2024 as part of our ongoing efforts to help control the cost of care.
Our current contract with CHI Memorial extends through June 30, 2024. If we aren’t able to come to an agreement before June 30, CHI Memorial facilities and affiliated providers will be out of network beginning July 1, 2024. CHI Memorial Health at Home will leave our networks March 29, 2024.
CHI Memorial’s pattern of behavior and latest rate requests have led us to reevaluate our partnership. One way we’re responding to CHI Memorial’s demands is considering other health system partners that could join Blue Network SSM alongside Erlanger and maintain affordability for our members. We’ll do this by issuing a request for proposal (RFP) from other area health systems to join the network. We owe it to local employers and our members to consider all our options. We’ll provide more information on this later in the spring.
Our members and employer customers are asking us for help in managing rapidly rising health care costs, and we have a responsibility to deliver.
In September 2021, we agreed to higher rates with CHI Memorial health system. Less than two years later, CHI Memorial began issuing demands for higher payment and requested to terminate our contract early. Our first responsibility is to our members, which is why we said no to ending our contract early and why we can’t agree to the unfair rates in their latest request. They asked for an increase of nearly $70 million over 3 years, a nearly 40% jump in rates, which would make them the most expensive hospital system in Tennessee.
BlueCross members will continue to have in-network access at CHI Memorial facilities and affiliated physicians through June 30 – and beyond, if CHI Memorial agrees to reasonable rates. If CHI Memorial ultimately leaves our networks, we’ll work proactively with BlueCross members to make sure they get the care they need.
Our Network S RFP gives CHI Memorial every opportunity to remain in the high-value commercial network. We hope CHI Memorial will do what’s best for their patients and our members by also agreeing to reasonable rates. We want to assure all our members that they will continue to have in-network access at CHI Memorial facilities and with their physicians through June 30, 2024 – and beyond, if CHI Memorial agrees to reasonable rates and terms. The only exception is CHI Memorial Health at Home, which will leave our networks March 29, 2024. We’re sharing this information now because we believe you deserve transparency.
If we cannot reach an agreement, CHI Memorial system facilities and affiliated providers will leave all BlueCross and BlueCare networks on July 1, 2024. If you’re in one of our impacted networks, any care you receive at CHI Memorial facilities or its affiliated providers on or after July 1, 2024, will be considered out of network.
If an agreement is not reached by June 30, 2024, all BlueCross members – including those in Network P, Network S, BlueAdvantage PPO, BlueCare Tennessee and BlueCare Plus – will need to seek care from other facilities beginning July 1, 2024.
If you’re covered by one of our plans, any care you receive at CHI Memorial facilities or from CHI Memorial providers on or after July 1, 2024, will be out of network, and you will likely pay more for the care you receive there. The only exception is CHI Memorial Health at Home, which will leave our networks even sooner, on March 29, 2024.
Our 2024 Medicare Advantage plans include generous out-of-network benefits to help keep your costs low. This means that, as long as CHI Memorial agrees to see you, you could continue seeing your preferred CHI Memorial-affiliated providers with limited cost differences.
To see the out-of-network benefits included in your plan, look at your Evidence of Coverage (EOC) here. You can find your BlueAdvantage plan on the middle left side of your Member ID card so you know which EOC to review.
We’re committed to coordinating care for our members and helping them get the services they need. We maintain an excellent network of hospitals and facilities where you and your family can get care. You can call the Member Service number on the back of your Member ID card or visit bcbst.com to find in-network providers.
View our list of alternative in-network facilities where you can seek care if CHI Memorial does go out of network.
Yes, you should always go to the closest emergency room in a true emergency. Emergency room benefits for true emergencies will not be affected if CHI Memorial leaves our network. Please note that, if admitted and once stabilized, you will need to be transferred to an in-network facility. See below for the definition of a true emergency.
An emergency is defined as a sudden and unexpected medical condition that manifests itself by symptoms of sufficient severity, including severe pain, that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect to result in:
- serious impairment of bodily functions
- serious dysfunction of any bodily organ or part
- placing a person’s health in serious jeopardy
Examples of emergency conditions include: (1) severe chest pain, (2) uncontrollable bleeding and (3) unconsciousness.
Doctors and Health Facilities
Scheduled Procedures/Ongoing Treatment
CHI Memorial facilities and doctors remain in our networks until June 30, 2024. Any authorized and scheduled surgeries between now and then will be covered as in network. We hope we can reach an agreement to keep CHI Memorial’s facilities and affiliated providers in our network beyond that time.
However, if we’re unable to reach an agreement and you use a CHI Memorial facility on or after July 1, 2024, you’ll be getting care out of network. That means you’ll pay more for the same care that you could receive from an in-network facility, and in some cases will have to pay the full amount for that care.
A note about home care: If you have surgery on or after March 29 and you need home care, call the number on the back of your Member ID to ensure your home-care option is in network, as CHI Memorial Health at Home will leave our networks effective March 29, 2024.
In the event we don’t reach an agreement by the June 30, 2024, deadline, you’ll have a few options when it comes to your care.
If you have ongoing services scheduled at a CHI Memorial facility, a nurse from BlueCross will work with you to help make sure you continue to receive appropriate care from an in-network health care provider. We want to be sure you don’t have any disruptions in care.
Under our Continuity of Care policy, some members under ongoing treatment may be able to have their CHI Memorial provider granted in-network status. Patients who may qualify for this include:
- Patients whose practitioner/facility are terminated from the network during treatment, i.e., chemotherapy or radiation patients
- Patients with complex medical and/or behavioral health conditions
If you think your care needs qualify for a provider to have in-network status, please call the Member Service number on the back of your Member ID card or complete this form and return it to: BlueCross BlueShield of Tennessee, 1 Cameron Hill Circle, Ste. 0002, Chattanooga, TN 37402-0002.