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Are negotiations with BCBSNC still ongoing or has the contract officially ended?

Since March, Mission Health tried to negotiate with BCBSNC for new contracts that cover the services we provide to its members. On July 5, 2017, we issued BCBSNC a formal notice of intent to terminate our existing contracts. BCBSNC was unwilling to engage in meaningful conversations, and as a result the contract has ended. Effective October 5, 2017, Mission Health is no longer an in-network provider with BCBSNC.

When do the contracts with BCBSNC end?

Effective October 5, 2017, Mission Health facilities and physicians are out of BCBSNC’s network. To our disappointment, BCBSNC pushed us off for months, wasting time we could have used to work in collaboration and make meaningful progress toward a new agreement. BCBSNC members will continue to have access to Mission Health and all our providers. Importantly, access to our Emergency Departments would continue as in network for all BCBSNC members. Being out of network doesn’t necessarily mean our healthcare services will be “higher priced.” Each BCBSNC product is specific to each patient, which means the out-of-network benefit may vary, as will the out-of-pocket cost.

IMPORTANT: Patients with Blue Cross Federal Employee coverage will receive in-network coverage until November 16, 2017.

What does this mean for me if I have BCBSNC health insurance?

All BCBSNC members will continue to have access to Mission hospitals and providers. Being out of network doesn’t necessarily mean Mission Health’s healthcare services will be “higher priced,” particularly given the fact that Mission’s prices are 23% less than our peer group hospitals, 7% less than local hospitals and 36% less than the highest priced hospitals in the state.

Each BCBSNC health plan is unique and members may have access to out-of-network benefits. Whether those benefits are more expensive or not is a function of the actual plan between their employer and BCBSNC. Further, Mission Health has a generous Prompt Pay Discount Policy and charity care policy that applies to co-pays and deductibles in addition to serving patients without any insurance at all. Given that, it’s quite possible that an individual may experience a very similar cost to access Mission even if we are forced out of network.

Regardless of our contract status with BCBSNC, access to our Emergency Departments is always on an in-network basis for all BCBSNC members. For additional information, patients can call our dedicated information line at (828) 412-6052 (select option 3) to leave a message and one of our representatives will return your call within one business day.

Which BCBSNC health insurance plans are affected by the contract ending?

All BCBSNC commercial and Medicare Advantage contracts are impacted. This includes employer-sponsored health plans, including the State Employees Health Plan, and health plans purchased on the Health Insurance Exchange.

BCBSNC Medicare Supplemental plans (also known as MediGap health plans) are not impacted, as they are not contracted with our health system.

What if a patient is hospitalized, pregnant or receiving treatment for a special condition on or after October 5, 2017?

Certain patients, including those hospitalized, in their second or third trimester of pregnancy, or undergoing a course of treatment when the contract ends, may be able to receive ongoing care for a limited time as part of the Continuity of Care transitional period. The length of the transitional period depends on the specific health plan. Patients should call the phone number on the back of their BCBSNC insurance card to find out if they are eligible and apply. When calling BCBSNC, please record the reference ID number you are provided and the name of the representative you speak with. This will help us if we need to make additional follow up with BCBSNC on your behalf. Patients must apply for Continuity of Care benefits no later than Sunday, November 19, (45 days from the contract end date of October 5). All applications sent after that date will be denied by BCBSNC.

We have a dedicated Continuity of Care Concierge Service team who can help patients complete the paperwork and submit to BCBSNC for review. Call (828) 412-6052, and select option 2 to speak with a team member. Or, visit a care manager onsite at Mission Health Cancer Center, room 115 Monday – Friday 8 a.m. to 5 p.m.

What if a patient has an emergency on or after October 5, 2017, when Mission Health is out of network?

BCBSNC members will always have access to our emergency rooms, regardless of our contract status with BCBSNC. If a patient experiences a medical emergency, they should always visit the nearest emergency room. Patients are entitled to in-network emergency care at any hospital until they are stabilized, and then any needed admission would require BCBSNC’s authorization.

What is Continuity of Care, and how do I know if I qualify from BCBSNC?

Continuity of Care is a process that allows current BCBSNC members to continue receiving care from an out-of-network provider for ongoing special conditions.

If your Mission Health primary care physician or specialist is out of network with BCBSNC and they are currently treating you for an ongoing special condition that meets BCBSNC Continuity of Care criteria, BCBSNC would have notified you 30 days before the contract end date (October 5, 2017). If you did receive a letter from BCBSNC advising you of the termination and their Continuity of Care policy, it’s important to respond to BCBSNC within the timeframe noted in the letter.

To be eligible for Continuity of Care, the patient must be seen by a participating Mission Health provider (this includes hospital services) prior to the termination (October 5, 2017). The patient must be actively being seen by the out-of-network provider for an ongoing special condition and the provider must agree to abide by the BCBSNC requirements for Continuity of Care.

An ongoing special condition means:

  • In the case of an acute illness, a condition that is serious enough to require medical care or treatment to avoid a reasonable possibility of death or permanent harm;
  • In the case of a chronic illness or condition, a disease or condition that is life-threatening, degenerative, or disabling, and requires medical care or treatment over a prolonged period of time;
  • In the case of pregnancy, the second and third trimesters of pregnancy;
  • In the case of a terminal illness, an individual has a medical prognosis that the member’s life expectancy is six months or less.

The allowed transitional period extends up to 90 days, except in the cases of:

  • Scheduled surgery, organ transplantation, or in-patient care, which shall extend through the date of discharge and post-discharge follow-up care or other inpatient care occurring within 90 days of the date of discharge;
  • Second trimester pregnancy which shall extend through the provision of postpartum care; and
  • Terminal illness which shall extend through the remainder of the individual’s life with respect to care directly related to the treatment of the terminal illness.

If available, patients should speak to their employer to see if there are Continuity of Care exceptions that may be available. Otherwise, patients should call the phone number on the back of their BCBSNC insurance card to find out if they are eligible and apply for Continuity of Care. When calling BCBSNC, please record the reference ID number you are provided and the name of the representative you speak with. This will help us if we need to make additional follow up with BCBSNC on your behalf.

Patients must apply for Continuity of Care benefits no later than Sunday, November 19 (45 days from October 5). All applications sent after that date will be denied by BCBSNC.

We have a dedicated Continuity of Care Concierge Service team who can help patients complete the paperwork and submit to BCBSNC for review. Call (828) 412-6052, and select option 2 to speak with a team member. Or, visit a care manager onsite at Mission Health Cancer Center, room 115 Monday – Friday 8 a.m. to 5 p.m.

How are patients who have BCBSNC coverage from another state or federal plan affected?

In some cases, out of state and federal Blue Cross coverage are part of the BCBSNC agreement. Those patients should contact Blue Cross to understand how their costs may change now that Mission Health is an out-of-network provider.

IMPORTANT: Patients with Blue Cross Federal Employee coverage will receive in-network coverage until November 16, 2017.

What other health insurance plans does Mission Health accept?

Commercial (employer-sponsored and Health Insurance Exchange)

  • Aetna
  • BMS TPA
  • Cigna
  • Coventry
  • CWI Benefits
  • Crescent TPA
  • Humana (CareChoice)
  • Healthgram TPA
  • Key Benefits Administrators TPA
  • MedCost
  • MedCost Ultra
  • MultiPlan PHCS
  • UnitedHealthcare
  • United Behavioral Health
  • WellPath
  • Western North Carolina Healthcare Coalition
  • First Carolina Insurance – First Medicare Direct Healthy State
  • Gateway Medicare Advantage
  • Humana Medicare Advantage
  • UnitedHealthcare Medicare Advantage
  • WellCare Medicare Advantage

Medicare Advantage

Are BCBSNC Medicare Supplemental health plans impacted by the contract ending?

No, BCBSNC Medicare Supplemental plans (also known as MediGap health plans) are not impacted. Even if we are out of network with BCBSNC, you will still have in-network access to all Mission providers.

Which Mission facilities are affected by the contract ending?

Our current negotiations with BCBSNC affect the following hospitals and associated providers:

  • Mission Hospital
  • Angel Medical Center
  • Blue Ridge Regional Hospital
  • CarePartners
  • Highlands-Cashiers Hospital
  • McDowell Hospital
  • Transylvania Regional Hospital

Asheville Specialty Hospital is not impacted.

Additionally, CarePartners Outpatient Rehabilitation Centers are not out of network until March 3, 2018.

Are physicians impacted by the contract ending?

Yes. Mission’s employed and contracted physicians are impacted by our contract ending with BCBSNC. There is one exception, however, which is our anesthesiologists who are not impacted. You can view a complete list of impacted hospitals and physician practices here.

The initial information on Blue Cross’ site was incorrect and stated that Mission physicians would not be out of network until March, if we did not reach agreement. This is only the case for physical, occupational, and speech therapy through CarePartners’ at seven locations, which doesn’t take effect until March 3, 2018, if we do not reach agreement on new contracts.

How substantial are the cost increases for accessing Mission Health facilities and providers at out-of-network rates?

Each health plan is unique to that particular member based upon the specifics of the insurance plan. We encourage BCBSNC members to call the customer service number on the back of their insurance card for more details.

I received a bill for services due to Mission Health’s out-of-network status with BCBSNC. Who can I contact to discuss financial assistance?

BCBSNC members who need additional information on our Prompt Pay Discount policy or financial assistance should call Mission Health directly at (828) 412-6052, and select Option 1 to speak with a representative.

What is the process for paying bills now that Mission Health is out of network with BCBSNC?

  1. After your visit, Mission will submit claims for your treatment directly to BCBSNC.
  2. Mission will notify you about next steps after we submit your claim to BCBSNC.
  3. Depending on your plan, BCBSNC may send you an Explanation of Benefits (EOB) for patients to send us (with the exception of Medicare Advantage patients). We must receive a copy of the patients EOB before we can assist the patient with their balance.
  4. The coverage indicated in the EOB is dependent upon the patient’s specific health plan’s benefits as set by BCBSNC.
  5. The patient will not be billed until their claim is processed.

Patients may be eligible for discounts. Mission is offering convenient ways to resolve balances with discounts and payment plans. Call (828) 412-6052 (select option 1) Monday – Friday, 8:00 a.m. to 4:30 p.m.

What is my financial responsibility as a BCBSNC member if I continue to receive services from Mission Health on or after October 5, 2017?

Patients may be eligible for discounts. Mission is offering convenient ways to resolve balances with discounts and payment plans. Call (828) 412-6052 (select option 1) Monday – Friday, 8:00 a.m. to 4:30 p.m.