State is hands-off in Mission, insurance company feud

Aug. 02--As the impasse between Mission Hospital and Blue Cross/Blue Shield of North Carolina moves into its second month, neither party is showing any sign of budging.

Unless an agreement is reached by Oct. 5, those in Haywood County with insurance through Blue Cross/Blue Shield of North Carolina will have to pay out-of-network rates at Mission Hospital and its various affiliates, including physician offices. Customers include those employed by the state or through the N.C. Teachers and Employees Health Plan, or anyone purchasing insurance through the federal marketplace exchange.

Don't look to the state of North Carolina to intercede.

A spokesman for the N.C. Department of Insurance said the agency plays no role in price negotiations between providers and insurers.

"The health insurance market in North Carolina is a voluntary open insurance market," wrote Colin Day, assistant director of public information for the N.C. Department of Insurance. "The commissioner has no authority to require any insurance company to participate or offer products in the state but often does encourage additional companies to come to N.C. to improve the choice of insurers. "

While the state's insurance laws require companies who desire to sell insurance in the state to be authorized by the commissioner, the most important factor is financial solvency, Day wrote.

The N.C. Office of State Treasurer has the authority to negotiate the administrative service contract between the N.C. Teachers and Employees Health Plan and an insurance company.

Karah Manning, the communications manager for the retirement systems division of the state treasurer department, said the plan's current third party administrator is Blue Cross and Blue Shield of North Carolina.

"Part of that contract is a requirement to provide a network that supports members in every county of North Carolina as well as the members that live throughout the United States," Manning wrote. "The expectation is that the network meets high quality standards and is competitively priced."

The current contract was awarded in 2012 with a go-live date of July 1, 2013. The contract is currently set to expire Dec. 31, 2018, and proposals are currently under evaluation for 2019 and beyond.

Manning provided a list of the area hospitals that are in-network in the western part of the state, which include both Harris Regional and Haywood Regional, as well as Pardee and Park Ridge hospitals in Hendersonville, plus several others in Hickory, Morganton, Boone and Burke County. Mission Hospital was not on the list provided on July 27.

Emergency care is always covered as an in-network benefit, and some State Health Plan members already in a treatment plan for certain conditions at a Mission facility may be able to keep receiving treatments as part of the continuity of care program, Manning wrote.

"The State Health Plan is constantly trying to find ways to bend the cost curve," she wrote. "We will continue to work with our partners to find ways to provide the best medical services to our members at the most appropriate cost."

Both the insurance company and hospital are taking their case to the public in the form of social media, advertising and newspaper columns.

Jan Plummer, is a health care navigator with Mountain Projects who assists consumers purchasing health insurance through the federal marketplace, said if Mission Hospital is out-of-network, costs will skyrocket under the current plans, which will remain in place until the end of the year.

She provided an example of a single female, 49, earning $25,000 a year who pays $108 a month for insurance (with the subsidy) and had an in-network deductible of $3,000. If an out-of-network provider is used, but deductible doubles, as does the out-of-pocket maximum amount a consumer would pay for the calendar year.

Plummer said the insurance marketplace open enrollment begins Nov. 1, and could have different plans than currently offered. She encouraged those to either go to the marketplace website or contact Mountain Projects when it comes time to review available possibilities, especially if Mission is considered out-of-network at that point.

Because of all the national talk about repealing Obamacare, Plummer said many people believe they will no longer get insurance through the marketplace.

"There are a lot of confused people," she said, "but nothing has changed. We will be enrolling people through Dec. 15 and are expecting to be super busy because the enrollment period has been shortened."

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