Updated: Blue Cross NC responds to Mission Health offer for health exchange customers

Mission Hospital's 12-story tower at 509 Biltmore Avenue. Image provided by HDR.
Mission Hospital's 12-story tower at 509 Biltmore Avenue. Image provided by HDR.

Editor’s note: this post was updated at 1:15 p.m. on Aug. 10 with the following statement from Blue Cross on Mission Health’s announcement. 

Statement from Blue Cross NC President and CEO Brad Wilson in response to Mission Health’s announcement regarding ACA members:

“Today we received a letter from Mission Health that attempts to partially rescind their termination of our contracts. We were disappointed when Mission Health decided to unilaterally terminate those contracts last month.

With today’s proposal, Mission Health continues to turn its back on senior citizens, state and county employees, businesses and taxpayers across Western North Carolina. This is unfair to tens of thousands of other members; therefore Blue Cross NC has no choice but to reject this offer.

We remain ready and willing to negotiate on behalf of ALL of our Western North Carolina members as soon as Mission Health fully withdraws its termination. A recent study validates that North Carolina already has some of the most expensive health care in the nation, and every increase in hospital costs leads directly to even higher premiums.

We hope that Mission Health reconsiders its decision to terminate our contracts. In the meantime, we will continue to work with Western North Carolina’s other doctors and hospitals – who share our goal of making quality, affordable health care available to as many North Carolinians as possible.”

Press release from Mission Health:

Mission Health announced today that it has taken proactive and immediate steps to protect options for consumers who participate in the North Carolina health insurance exchange. Specifically, Mission Health has offered to stay in-network and accept its current payment rates with no increase from Blue Cross Blue Shield of North Carolina (BCBSNC) for care provided to anyone covered by a policy purchased on the exchange. Mission Health will honor these current payment rates – the “forever zero” approach BCBSNC has demanded – for all persons insured through the exchange for 2018 or until such time as a new agreement is reached with BCBSNC that covers all care provided to all patients.

Mission Health made this announcement because BCBSNC is currently the only insurance company participating on the exchange in western North Carolina. Unlike employers selecting their benefit plans and seniors purchasing Medicare Advantage coverage who have multiple excellent choices available including newly revised programs from Aetna, Cigna and Healthy State, consumers evaluating their 2018 health insurance coverage unfortunately only have one choice.

“We take our responsibility as western North Carolina’s only safety net health system incredibly seriously,” said Ronald A. Paulus, MD, president and chief executive officer of Mission Health. “Our commitment goes far beyond providing nationally recognized, high quality, cost-effective healthcare to our community. We understand that those purchasing insurance on the exchange are among the most vulnerable in our region and have no alternative, so it is our responsibility to ensure that access to health insurance – a life transforming event – remains available to everyone. By accepting BCBSNC’s “forever zero” approach for these individuals, we can help protect those who have exchange-based insurance, some being insured for the first ever time in their lives.”

The current contract between Mission Health and Blue Cross Blue Shield of North Carolina expires at midnight on October 4, 2017. Negotiations must result in a new agreement by midnight on October 4, 2017, for Mission Health to remain in the BCBSNC network for all consumers, including those covered by policies purchased on the exchange. This announcement effectively excludes those on the exchange from being impacted by BCBSNC’s unwillingness to even speak with us about a contract critical to Mission Health’s long run survival.

Mission Health recently announced fundamentally revised agreements with Aetna and Cigna that offer new choices for local employers. Mission Health continues to negotiate with a number of plans with the goal of increasing consumer choices on the exchange as well.

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14 thoughts on “Updated: Blue Cross NC responds to Mission Health offer for health exchange customers

    • Alex Hawkins

      In reply to bssummers who wants single payer, the whole reason that Mission needs more from BCBSNC is because about 70% of their patients are through the “single payer” – the government!! And they CAN’T survive on the amounts the government pays. Why on earth do you think that if everyone (including YOU) is under the governmet payment system that the hospitals and doctors can stay in business?!

      • bsummers

        Oh, I don’t know – maybe because it works well in other countries, like our neighbor to the north, Canada. Out of the world’s developed countries, the US spends the most per-capita (by far) on health care.
        https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

        And by most measures, we have lousy results for all that spending. Why? Perhaps because a huge percentage of all that money goes to overhead and profits for the companies who stand between us and our doctors.

        If instead of spending all that money on glitzy insurance company advertising, executive salaries, lobbying, massive corporate headquarters, etc., we spent all of it (or less, frankly) solely on health care, imagine how much better it would be for all of us.

        But if you want to see the current misery and infighting continue, by all means lets stick with the stupid system we have now.

        • NFB

          “Out of the world’s developed countries, the US spends the most per-capita (by far) on health care.”

          Well, yeah, you know, “American exceptionalism” and all.

      • luther blissett

        “they CAN’T survive on the amounts the government pays.”

        Have you ever noticed how many people Mission employs in medical coding, billing and collections? (That’s even before looking at their marketing and PR budget.) Have you ever noticed that when Mission acquires a specialist facility — something they’ve done a lot over recent years, even as they stop maternity services in Franklin — procedures start to be billed at hospital rates?

        As Barry says, every other developed nation spends about as much per capita per year on health care and gets the same or better medical outcomes. There is grift and waste and stupidity in every part of the American system, and we all suffer as a result.

        A plague on both their houses.

  1. Don

    Mission Health and BCBSNC…. kind of like the choice (READ, lack thereof) in the last election between Hubris (the Clintons) and Pompous (TheRump). No good came of it then…. obviously….. and no good will come of this either. These for profit monopolies need to be abolished (oh right, Mission and BCBSNC are non-profit entities…. RIDICULOUS and UNSUSTAINABLE).

  2. NFB

    BC says:

    “We remain ready and willing to negotiate on behalf of ALL of our Western North Carolina members”

    Mission says:

    “We take our responsibility as western North Carolina’s only safety net health system incredibly seriously”

    Then stop this PR crap and work out a deal. People’s health care and lives are more important that your simultaneous temper tantrums. Until you show us your press releases are nothing but hot air.

    • bsummers

      There truly is no better argument for single-payer than this embarrassing display. Two near-monopolies using that status to fight between themselves for higher profit margins, while scaring the hell out of people who have little choice but to depend on them to stay alive. The CEOs of both companies need to be frogmarched in front of a judge, and the whole thing scrapped for Medicare-for-all.

      Excellent op-ed by a local columnist:

      http://carolinacommentary.com/why-congress-hates-medicare-for-al/

  3. FedUpWithBS

    It’s disgusting how non-profits continue to generate huge sums of profits all on the backs of the sick and needy.

  4. Carrie

    BCBS’s statement says, ” A recent study validates that North Carolina already has some of the most expensive health care in the nation.” Is there a citation provided? I’d like to see this study.

    • bsummers

      It’s worth noting that along with being more “expensive”, North Carolina is near the bottom in terms of “access”. Fewer people with insurance, fewer people with a primary care doctor, lower Medicare/Medicaid acceptance rate with doctors, etc. are all symptoms that lead to people using the ER as their primary medical care, therefor the most expensive.

      Single-payer would take care of this.

  5. Marsha V Hammond PhD

    Mission Hospital loses $$ due to poor Quality Control (QC), if I am any example of that. In Feb, 2017, Mission violated industry protocols by administering an overdose of an anti-arrhythmic drug to me resulting in my cardiac arrest. Pfizer, the manufacturer, has a very clear protocol which Mission violated. I demanded an immediate transfer to UNC CHAPEL HILL University Hospital where I received over $100,000 of BCBSNC covered standardized, appropriate medical care—3.5 hours away. It’s better than being dead. Mission’s monopolistic stance leads it, apparently, to flying by the seat of its pants medical care. I reported the event to its accreditation agency, The Joint Commission. Do right by yr patients, Mission, and you won’t lose yr patients to other more qualified systems. Marsha V Hammond PhD Licensed Psychologist NC

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