9 ongoing payer-provider contract disputes and recent splits

Some payers and health systems have split in recent weeks, unable to meet year-end contract deadlines. Others are facing looming deadlines to reach agreements without disrupting patient care. Here are nine ongoing contract disputes and failed negotiations, as of Jan. 10. 

  1. Regence BlueShield of Washington Medicare Advantage members have been out of network with Optum-owned Everett Clinic and Polyclinic since Dec. 5. The two sides reached an agreement to keep commercial members in network on Dec. 22. Negotiations between the clinics and Regence BlueShield are ongoing as of Jan. 9. 

  1. Anthem Blue Cross could go out of network with Fredericksburg, Va.-based Mary Washington Healthcare if the two sides can't agree on a new contract by March 1. Mary Washington Healthcare operates two hospitals and over 50 other facilities. 

  1. Centene and Springfield, Mo.-based CoxHealth will go out of network Feb. 16 after the two sides were unable to reach a new contract agreement. Centene subsidiary Home State Health administers Missouri's specialty health plan for current and former foster children and individuals receiving adoption assistance payments. 

  1. BCBS Texas and Ascension hospitals in Texas are facing a looming Feb. 1 deadline to avoid a split that could impact 66,000 patients. A spokesperson for BCBS told the Austin American-Statesman Jan. 6 contract negotiations are "not at an impasse," and the two sides continue to talk.

  2. BCBS Tennessee is out of network with Memphis, Tenn.-based Methodist Le Bonheur Healthcare after the sides were unable to reach a new agreement by Dec. 31. The split affects those with employer-sponsored health plans through BCBS, and many with TennCare — the state's Medicaid program — who have plans administered through BCBS.  

  1. BCBS Oklahoma could go out of network with Stillwater (Okla.) Medical Center on May 1 if the sides are unable to agree on a new contract. In a Jan. 3 statement on its website, Stillwater Medical Center said the current contract expired Dec. 31. The two sides will go out-of-network if an agreement is not reached by the end of a 120-day transition period ending April 30. 

  1. UnitedHealthcare, Cigna and Anthem members are out-of-network with Clovis, Calif.-based Community Health System. The health system failed to reach an agreement with the three payers before the Dec. 31 contract deadline. 

  1. BCBS Texas could go out of network with Abilene, Texas-based Hendrick Health if a new contract is not in effect by Feb. 1. The termination would affect those with Blue Choice PPO, Blue Essentials and Blue Advantage HMO plans.

  2. Cigna will be out of network with Phoenix Children's Hospital if the sides are unable to reach a new contract by Feb. 1, the Phoenix Business Journal reported Dec. 2. 

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Top 40 articles from the past 6 months