Amid a rate negotiation deadlock, Asheville, N.C.-based Mission Health System offered to continue in-network recognition of Blue Cross Blue Shield of North Carolina's ACA exchange policyholders Thursday; however, BCBSNC quickly rejected the proposal.
Here are five things to know.
1. Last month, Mission Health said it plans to leave BCBSNC's network by Oct. 5. Mission Health board members wrote in a July 24 op-ed the system requested a "modest, mid-single digit reimbursement increase," but BCBSNC denied the ask, "forcing a 'forever zero' contract." BCBSNC refuted Mission Health's requested fee hikes, stating the system "is among the most expensive facilities for common inpatient procedures."
2. While a contract lapse between the organizations would affect all BCBSNC policyholders — including members with employer-based, Medicare Advantage and exchange plans — Mission Health said Thursday it would honor current payment rates for only BCBSNC customers purchasing coverage through the state's ACA marketplace for 2018, or until an agreement is inked for all BCBSNC members. Mission's proposed exemption "excludes those on the exchange from being impacted by BCBSNC's unwillingness to even speak with us about a contract critical to Mission Health's long run survival."
3. Mission Health said it extended the offer because BCBSNC is the only payer participating on the exchange in western North Carolina. Roughly 50,000 individuals in western North Carolina purchase plans through the individual marketplace, Citizen-Times reports.
4. However, BCBSNC denied the exemption later Thursday. In a statement obtained by Mountain Xpress, the payer said Mission Health's proposal "attempts to partially rescind their termination of our contracts. We were disappointed when Mission Health decided to unilaterally terminate those contracts last month. With today's proposal, Mission Health continues to turn its back on senior citizens, state and county employees, businesses and taxpayers across western North Carolina. This is unfair to tens of thousands of other members; therefore Blue Cross NC has no choice but to reject this offer."
5. BCBSNC added it remains "ready and willing to negotiate on behalf of ALL of our western North Carolina members as soon as Mission Health fully withdraws its termination."