Blue Cross Blue Shield, Dignity Health fail to reach contract

Blue Cross Blue Shield, Dignity Health fail to reach contract


Here’s what we know about the failed contract between Dignity Health and Blue Cross Blue Shield of Arizona

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For many Phoenix residents with health insurance through Blue Cross Blue Shield, Dignity Health is no longer considered in-network, meaning some patients will need to find new ones as the state faces a shortage of primary care providers. provider.

Contractual disputes between healthcare providers and insurance companies are common, but agreements are often reached at the 11th hour before contracts expire and patients are directly affected. Such was the case in the recent disputes between Phoenix Children’s Hospital and Aetna, Blue Cross Blue Shield and Southwest Medical Imaging.

But a last-minute deal wasn’t reached on the Dignity Health contract with Blue Cross Blue Shield of Arizona, which could affect thousands of people.

The contract ends Feb. 1, which means some people with health insurance from Dignity Health providers and Blue Cross Blue Shield will need to seek care elsewhere or face high out-of-network medical bills.

Dignity Health is a major healthcare provider in Silicon Valley with facilities including Dignity Health St. Joseph’s Hospital and Medical Center in Phoenix, which includes the world-renowned Barrow Neurological Institute. The lack of a contract could impact health care for thousands of Arizona residents.

“As one of the highest quality healthcare organizations in the region, we do not underestimate our responsibility to provide life-saving care today and into the future,” Dignity Health said in a written statement. “Patients are at the center of everything we do, and we Recognize the inconvenience this situation causes.”

Yavapai Regional Medical Center and the patients who use the center will not be affected by the contract issues, Dignity officials said.

Here’s what we know so far about the failed contract.

Blue Cross Blue Shield says it has notified 16,000 members who filed claims against Dignity Health in the past year

The lack of contracts affects most, but not all, Maricopa and Pinal County residents with Blue Cross Blue Shield coverage. Anyone who has Blue Cross Blue Shield coverage through the federal employee program, Medicare Advantage or the Affordable Care Act (Obamacare) plan for individuals and families, Blue Cross Blue Shield of Arizona, will not be affected, officials said.

The lack of a contract affects more than just Blue Cross Blue Shield of Arizona employees. It also affects people who seek care at Dignity Health through out-of-state Blue Cross Blue Shield plans, such as Blue Cross Blue Shield of Texas.

“We have communicated with other plans and have the same protections in place for continuity of care and access to emergency care,” Blue Cross Blue Shield of Arizona said in a written statement.

Affected patients can make a “Continuum of Care Request” to retain their Dignity Health provider

This form can be found online by visiting www.azblue.com/provider/resources/forms and selecting Care Management Referral Form.

“For members who are receiving care at Dignity, they can continue to receive care,” Blue Cross Blue Shield of Arizona officials said in a separate written statement. “We have care teams ready to help, including our Clinical Rapid Response Team. … We are here to make sure all members get the care they need.”

Members can also contact 24/7 service at [email protected].

Renee Hunt, vice president of brand and reputation management for Blue Cross Blue Shield of Arizona, said anyone who has accepted a Blue Cross Blue Shield plan and has scheduled surgeries and procedures can complete services and any follow-up care, and if a member is “inappropriately denied,” We will work to intervene and correct. “

“Dignity Health providers have an obligation to continue providing care to members who are scheduled for surgery or who are being treated for certain conditions within the network,” she wrote in an emailed statement. “If a member is unsure whether you have continuity Sexual Care Rights, we have a team ready to help, please contact us.”

Emergency room care will continue to be in-network and unaffected

“For our regular members, if they need emergency care, they can go to all area hospitals, including in-network Dignity hospitals,” a statement from Blue Cross Blue Shield of Arizona said.

Dignity Health accuses Blue Cross Blue Shield of Arizona

Dignity Health officials said that “despite our best efforts,” Blue Cross Blue Shield of Arizona “has been unwilling to accept fair contract terms.” In a statement provided to The Arizona Republic, Dignity Health continued to say it never intended to leave the Blue Cross Blue Shield of Arizona network.

“We submitted several proposals to BCBSAZ, but they rejected them all. We also offered to extend the negotiation period by a further two weeks to avoid disruption to our patients, but BCBSAZ rejected our extension offer without offering a counter-offer, Resulting in the termination of the existing agreement,” the statement said.

“We are extremely disappointed that BCBSAZ did not formally notify us of their decision to remove us from the network.”

Dignity Health says Blue Cross Blue Shield refuses to pay millions of dollars in claims

“We had hoped BCBSAZ would work with us to develop a collaborative solution, but they have done the opposite,” a statement from Dignity Health said. “In fact, BCBSAZ has not even complied with the terms of our existing contract: Despite our repeated requests for relief, they have refused to pay millions of dollars in outstanding claims for the care our providers have already provided.”

Hunter, a vice president at Blue Cross Blue Shield of Arizona, said the insurance company is not refusing to pay the claim and “while contract negotiations are ongoing, Dignity claims are still being processed on a daily basis in the normal course of business.”

Hunter wrote in an emailed statement that Dignity Health hospitals send approximately $100 million in billing claims each month to the Arizona insurance company, commonly known as AZ Blue.

“Claims are received and processed on a daily basis, and we work closely with our providers to ensure billing is appropriate and claims are paid accurately,” Hunter wrote. “As of January 31, we have received Dignity bill charges in the amount of approximately was $102 million, which was in line with our expectations. … To add to that, AZ Blue receives and processes $8 billion in billing expenses annually from hospitals.”

Blue Cross Blue Shield of Arizona officials say they are ‘defending affordability’

Asked about the contract termination, Blue Cross Blue Shield of Arizona said in a statement: “Our greatest concern is that profitable hospitals will make health care more expensive for Arizona families.”

Blue Cross Blue Shield of Arizona and Dignity Health have web pages dedicated to providing information about contract issues.

The Blue Cross Blue Shield page says the health insurance company “worked hard to keep Dignity Health in the AZ Blue network, but they have repeatedly rejected many of AZ Blue’s fair and reasonable price increase offers.”

The page also says it’s part of Blue Cross Blue Shield’s job to ensure unnecessary growth is controlled and that Dignity has been compensated at the top of the Arizona market.

Dignity Health says ‘conversations continue’ with Blue Cross Blue Shield

“Although our contract with BCBSAZ has been terminated, we will continue to work in the best interests of our patients and hope to reach a new agreement with BCBSAZ,” Dignity Health said in a statement. “We encourage patients to visit keepdignityhealth.org to stay informed. situation, or call 877-264-3264 with questions about their coverage, including continuity of care.”

Contact healthcare reporter Stephanie Innes at [email protected] or 602-444-8369.Follow her on X (formerly Twitter) @stephanienis

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