BCBSNE open to negotiating after rejecting CHI proposal

Blue Cross and Blue Shield of Nebraska (BCBSNE) will not accept CHI’s latest proposal in the contract dispute between the two companies, but BCBSNE officials say they welcome the opportunity to discuss real solutions that make sense to Nebraskans.”

CHI Health presented a contract proposal on Monday in an effort to rejoin BCBSNE’s statewide provider network. BCBSNE terminated CHI’s contract on August 31 because CHI costs 10% to 30% more than other providers in Omaha, and has been unwilling to bring its costs in line.

Although the proposal called for a $10 million cost reduction in 2015, CHI costs $60 million more annually than other providers in Omaha for the same services. The proposal also asked for increases at CHI’s Lincoln facilities of 20% at Saint Elizabeth Regional Medical Center and 37% at the Nebraska Heart Hospital. In total, the proposal accounted for less than a 2% cost decrease.

“We carefully evaluated CHI’s proposal, but in the final analysis it doesn’t do nearly enough to seriously address the cost differences between CHI and other providers,” said BCBSNE senior vice president Pat Bourne. “We have a responsibility to our members to hold the line on rising health care costs.”

CHI imposed a 72-hour deadline for accepting a proposal with little detail, and told BCBSNE’s team there was “no room for negotiation” on the offer. Bourne said there are elements in the proposal BCBSNE could begin to build a new contract on—if CHI would have been open to it.

“We believe their approach does not move us closer together,” Bourne said. “And it tells us CHI is not really interested in working together to reach an agreement for our members and their patients.”

Bourne said it was especially troubling that CHI announced in the proposal letter that beginning January 1, it would bill patients with BCBSNE coverage in 5 Nebraska communities the full amount for services, rather than accept the previous in-network amount CHI promised to take as payment in full.

Last week, BCBSNE announced that it was extending in-network benefits for members who used CHI hospitals in Grand Island, Kearney, Nebraska City, Schuyler and Plainview. CHI’s plan to bill the difference between what BCBSNE pays and the full amount of services could add significant costs for members.

“We are extremely disappointed with CHI’s attempts to lock our members out of care in those communities—or charge them more if they get care at those facilities,” Bourne said. “We will work with our members to get the care they need, maximize their benefits and avoid CHI’s higher out-of-network costs.”

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.