Contract Terminated Between Children’s Minnesota and Blue Cross and Blue Shield of Minnesota

By a News Reporter-Staff News Editor at Insurance Weekly News -- As of July 5, Children's Minnesota is no longer an "in-network" provider for Blue Cross and Blue Shield of Minnesota (Blue Cross) members who are covered through employer-provided or individually purchased Blue Cross health insurance plans or the Blue Cross Blue Plus PMAP program. After months of negotiations, both parties were unable to come to an agreement.

"Blue Cross gave Children's an impossible ultimatum, knowingly threatening our ability to care for the kids and families that rely on us every day and the vitality of our organization," said Bob Bonar, CEO at Children's Minnesota. "We're disappointed that Blue Cross has been unwilling to find common ground given the scale and scope of vital pediatric services that we provide in this community."

Blue Cross triggered this by demanding a 31% cut to Medicaid reimbursement and threatening us with no future inflationary rate increases for care to those with private insurance. Even after months of negotiations, Blue Cross remained at double-digit reduction demands for the payments we receive for efficient, high quality pediatric care. On average, Children's currently receives from payers about 70 cents for every dollar of cost actually incurred to care for patients insured through Medicaid. Accepting Blue Cross' cut puts our organization at risk and jeopardizes our ability to sustain vital services and programs that provide critical pediatric care to children in the region.

Blue Cross members no longer have insurance coverage for most services provided at Children's facilities, including the Minneapolis and St. Paul hospitals, Special Care Nursery in Coon Rapids, 12 primary care clinics, all specialty clinics, six rehab sites in the Twin Cities and the Minnetonka Ambulatory Surgical Center and home care services. While patients still have access to Children's emergency departments for emergency care, families are encouraged to consult with their carrier to understand the impact on their out-of-pocket costs, should a child need to be admitted to the hospital.

Additionally, Blue Cross may cover care provided at Children's Minnesota facilities, but at varying amounts based on each family's out of network benefit rules and/or only with special authorization from Blue Cross. In many cases, this means patient's out-of-pocket costs for accessing care will be higher.

Children's Minnesota is committed to continuing to work at resolving differences with Blue Cross. To learn more about the effort and to get involved, please visit www.StandTallForSmall.org.

Keywords for this news article include: Medicaid, Pediatrics, Health Policy, Children’s Minnesota.

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