BCBSNE contract with CHI Health, UniNet will expire Sunday

Effective Monday, September 1, more than 1,000 Omaha-area physicians and several Nebraska hospitals affiliated with Denver-based CHI Health will not be part of Blue Cross and Blue Shield of Nebraska’s statewide provider network.

BCBSNE’s contract with UniNet—which represents CHI Health facilities across Nebraska and a group of Omaha-area physicians—terminates at midnight Sunday and no further negotiation meetings are scheduled before then.

BCBSNE has been in contract negotiations with UniNet since April in an effort to reach an agreement that would bring CHI's costs in line with other providers in Omaha.  CHI Health affiliate Alegent Creighton costs up to 30 percent more than other Omaha-area providers. UniNet’s “best and final” offer called for an overall cost reduction of less than 1%, and even proposed a 21% cost increase at a Lincoln facility.

“Unfortunately, we were not able to reach an agreement that addressed our serious cost concerns,” said BCBSNE senior vice president Lee Handke. “Throughout these negotiations, our position has remained firm:  We have a responsibility to hold the line on costs on behalf of our members, and we cannot allow one provider to cost significantly more than others.

“CHI has been unwilling to address its high costs, offering minimal reductions and rejecting offers to bring their costs in line with the rest of the market. That is unacceptable as we work to protect the interests of our members.”

BCBSNE senior vice president Pat Bourne said BCBSNE is now shifting its attention to helping members get the medical care they need, and avoid significant out-of-network costs by helping them find an in-network provider. Members who utilize out-of-network providers are reimbursed lower amounts, and providers could also bill the remaining full charge for services after out-of-network benefits are applied.

BCBSNE has established a dedicated website ( www.nebraskablue.com/update ) and a hotline (844-286-0855) with resources to help members manage their care. Providers such as Nebraska Methodist Health System and The Nebraska Medical Center also have dedicated resources to help BCBSNE members find a new provider.

“We’ll do everything we can to help our members and make this as painless as possible,” Bourne said.

Handke added that BCBSNE will continue negotiating with UniNet/CHI Health after Sept. 1, in hopes of reaching an agreement that is fair and beneficial to members and that addresses CHI’s high costs.

“We want CHI in our network,” Handke said. “But for now, they have priced themselves out of our network. They will have to get serious about addressing their high costs before we would sign a new agreement.”

HEALTH INSURANCE TERMS


COINSURANCE

The percentage of the bill you pay after your deductible has been met.

COPAY

A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 

DEDUCTIBLE

The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.

SUBSTANCE ABUSE DISORDER SERVICES

Includes behavioral health treatment, counseling, and psychotherapy


in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)

out-of-pocket

Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.

penalty

If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.

premium

The amount you pay to your health insurance company each month. 


Preventive services

Health care services that focus on the prevention of disease and health maintenance.

rehab SERVICES

Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).

specialist

A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.