Opinion: How BlueCross is ensuring access to care during network changes

The Daily Memphian Latest Updates

Kevin Woods, January 26, 2023

At BlueCross, we’re committed to supporting the well-being of our members — and we’re continuing negotiations with Methodist Healthcare, which includes Le Bonheur Children’s Hospital, to restore access to in-network care.

We don’t make changes to our network lightly and understand the anxiety this can cause. We only take this action when it supports the long-term well-being of our members.

It’s also our responsibility to make sure members have access to the care they need — and our teams are working hard to do just that.

BlueCross members who reach out to our customer service team are being connected with the care, treatments, and procedures they rely on. Unfortunately, that fact hasn’t come through clearly in all the attention surrounding these contract negotiations.

We are redirecting members to other high-quality providers in the area, and when that’s not possible, we’re ensuring they still have access to the care from Methodist or Le Bonheur, despite these facilities canceling many procedures unnecessarily.

Another element missing from all the recent discussion is tough questions for Methodist:

  • Why does Methodist think it’s okay to charge BCBST members more than they do people with other insurance?
  • Why are they canceling or delaying procedures instead of reaching out to BCBST (or the right BlueCross plan) for specific patients with specialized needs?

We began negotiating in good faith with the Methodist system six months ago because their rates are significantly higher than our average rates for other facilities in the Memphis area — and in the case of Le Bonheur Children’s Hospital, the highest of any children’s hospital in the state by far.

Methodist’s publicly available, self-reported data confirms Methodist charges BlueCross — and therefore you — more than they do other insurers. According to this data, for adult services BlueCross pays $43 for every $100 charged at a Methodist facility. Meanwhile, our competitors average only $28 per $100 charged. And at Le Bonheur Children’s Hospital, for every $100 billed to other insurance companies, they pay $59. For every $100 billed to BlueCross, we pay $79.

Throughout these negotiations, we did everything we could to protect our members. We even proposed a separate contract to keep Le Bonheur in our networks. Methodist has rejected all our offers. It’s worth noting that the Methodist system has Le Bonheur-only contracts with other insurers who, like BlueCross, are not their preferred partners, so it’s unfortunate to see them using Le Bonheur as a negotiating tactic and impacting children’s care

BlueCross and our nearly 300 local employees are committed to the Memphis community, and we’ll continue serving our members and customers in the region. Our BlueCross Foundation remains active, funding Healthy Places and Power of We Scholarships in Memphis. We are also helping our members with access to affordable care with four state-of-the-art Blue of Tennessee with Sanitas Medical Centers in West Tennessee.

We’re a not-for-profit health plan focused on delivering affordability and, above all else, peace of mind for our members and group customers. Thank you for your patience as we work to get the savings you need. Our teams are standing by to ease anxiety for anyone impacted by this disruption by working one-on-one with members to make sure they continue to have access to the care they need.

The best way for us to support every unique situation is for members to call us using the number on the back of their I.D. card. We’re also available to live chat on our website (bcbst.com) and on our mobile app. Also, bcbstnetworkupdates.com has FAQs for members, along with all the latest information about negotiations

Our members continue to have access to the full range of quality care, including services from other Memphis-area providers through our partnerships with Baptist Memorial Health Care, St. Francis Hospital and Regional One Health. Those providers offer most of the same services available at Methodist, especially for adults. And we’re diligently evaluating unique situations that involve requests to continue covering specialized care at Methodist Le Bonheur facilities.

We will continue to make every effort to reach a deal that brings Methodist back into our networks, and we hope Methodist will work with us toward this goal.

Read the article on The Daily Memphian’s website here.