A network dispute between Brentwood, Tenn.-based TriStar Health, a subsidiary of Nashville, Tenn.-based HCA Healthcare, and BlueCross BlueShield of Tennessee produced $14 million in patient balance bills, according to an article submitted to the Tennessean by Alex Tolbert, founder of consulting group Bernard Health.
While HCA TriStar hospitals are not part of BCBST's Network S, the two parties had an agreement under which BCBST Network S members would access HCA TriStar hospitals' emergency services at in-network rates. However, that agreement ended in January.
As a result, HCA reported TriStar racked up 1,700 out-of-network claims totaling $14 million between January and March 22. HCA announced it will soon begin balance billing BCBST members for the out-of-network claims, Mr. Tolbert writes.
According to the Tennessean, BCBST said HCA's figures should not be taken at face value, and the insurer is going to review the numbers. HCA also said it will at first cap the amount it balance bills from emergency room outpatients at $1,500 and ER inpatients at $4,500. Other BCBST members with self-funded plans could be on the hook for more.
The sticking point of the dispute is rate negotiations. BCBST has said HCA is using aggressive balance billing practices, while HCA argues BCBST is reimbursing the hospital at too low of rates, according to Mr. Tolbert.