The dispute between the CommonSpirit Health Memorial Health Care System and Blue Cross and Blue Shield Tennessee could leave at least 38,000 patients paying for services in a group of health care providers in Chattanooga, Tennessee.
The controversy marks at least a third institution owned by CommonSpirit Health to publicly challenge the Blues contract this year.
“Memorial has partnered with Blue Cross for many years and we are disappointed and frankly surprised to find ourselves at this stage,” a BCBS Tennessee spokesman wrote in an email.
The nonprofit insurance company and CHI Memorial are negotiating a new deal from the end of 2020, and if they can’t get a new contract by September 7, the healthcare system will be taken offline for a payer 3.5 million. members. CHI Memorial said its goal was to reach an agreement with BCBS Tennessee and that it negotiated with the insurer “in good faith” but stated that it “could not reach an agreement on fair and equitable terms of reimbursement.”
“The COVID-19 pandemic has highlighted the really important nature of high quality local care,” a spokesman for the MHI Memorial wrote in an email. “Now more than ever, patients need access to caregivers and services they trust. The renewed contracts with BCBST will enable us to continue to withstand the pandemic and maintain access to essential services. ”
The dispute represents at least the third disagreement between Blues plan and CommonSpirit Health service provider in 2021, and arises from the fact that some insurers accuse health systems of using their ads after COVID-19 to publicly put pressure on insurers to raise rates.
Earlier this week, Anthem Blue Cross and CommonSpirit’s Dignity Health said they were unable to agree to the new contract, removing California’s largest hospital network from Anthem’s network effective July 16. Cancellation has affected more than 1 million patients, Dignity reports.
In January, CHI St. Luke’s CommonSpirit Health announced a new contractual agreement with Blue Cross and Blue Shield of Texas, ending months of disagreement that could have prevented 65,000 patients from accessing the system’s facilities in Houston.
CommonSpirit Health did not immediately respond to an interview request about the reasons for disagreeing with Blue Cross and Blue Shield’s US plans. The Chicago-based healthcare provider is the largest nonprofit healthcare system in the United States, with 140 hospitals. 21 states. It was formed in 2019 by the amalgamation of Catholic Health Initiatives (CHI) and Dignity Health.
At the end of the last quarter ending March 31, CommonSpirit Health reported operating income of $ 539 million. But his profits were supported by the sale of its revenue cycle management company Optum360 for $ 500 million and federal incentive grants. Excluding these items, CommonSpirit lost $ 117 million in operating activities during the quarter.