Local hospital, Blue Cross & Blue Shield don't reach contract

Local hospital, Blue Cross & Blue Shield don't reach contract

MOREHEAD CITY, Carteret County - Carteret Health Care and Blue Cross and Blue Shield of North Carolina have not been able to reach a new contract, according to BCBSNC. This means Carteret Health Care will become out of network for BCBSNC customers seeking non-emergency care at the hospital in Morehead City.

Carteret Health Care responded with this: "Carteret Healthcare (CHC) is deeply troubled by BlueCross BlueShield of North Carolina's (BCBSNC) announcement [Monday]. The state's largest insurer has decided to give notice of ending our long-standing relationship effective February 1, 2016. We are disappointed that BCBSNC has chosen to take such a public and aggressive action rather than work collaboratively with us to reach a new, rebalanced agreement."

According to BCBSNC representatives, after three years of unsuccessful negotiation attempts, the contract between Carteret Health Care (CHC), formerly known as Carteret General Hospital, and Blue Cross and Blue Shield of North Carolina (BCBSNC) will end on Feb. 1, 2016. Negotiations between the hospital and BCBSNC have reached an impasse, meaning that CHC will become out of network for BCBSNC customers seeking non-emergency care at the hospital.

"With little progress after months of attempting to negotiate reasonable terms with the hospital, we must now turn our full attention to our customers to make sure they understand how this impacts them," said Mark Werner, BCBSNC vice president of Network Management.

But according to Carteret Health Care spokesperson Michelle Lee, "We have been actively negotiating with BCBSNC for quite some time, and have provided multiple offers that seek a fair contract for both parties. In fact, we have made concessions in every single offer we've given to BCBSNC. Earlier this year we were making progress with regular touch points and even agreed on specifics of a new contract. However, without notice, BCBSNC changed our account representative and has refused to meaningfully collaborate with us ever since. Additionally, we have yet to see any written counter offer to our multiple proposals. Instead, they demand Carteret accept their proposed contact terms, with their reduced rates, which equates to a multi-million decrease over the next three years. Then, BCBSNC brought the entire community in the middle of our negotiations, forcing us to respond in kind. This isn't exemplary behavior from the state's largest health insurer."

BCBSNC said it will work to ensure a smooth transition for BCBSNC customers in the Carteret County area over the next few months. These contract changes do not affect Medicare Advantage customers. While the hospital facility will be out of network, Carteret Medical Group physician services will remain in network.

"Carteret Health Care is the only hospital in the state that insists on raising costs for BCBSNC customers without negotiation," Werner said. "This is unacceptable considering that our customers already pay more at Carteret Health Care than at similar hospitals."

Carteret Health Care responded with this: "We want to negotiate with BCBSNC on a new, rebalanced contract that is fair and reasonable to our health system, patients and the entire community. Simply put, we cannot accept a contract that threatens our financial stability as an independent hospital.  All we are asking for from BCBSNC is a contract that protects the financial sustainability of our hospital. BCBSNC is asking us to sign a contract that allows them to unilaterally make changes and gives them complete control. If we were to sign this type of contract, the long-term implications could be significant to our hospital and the overall healthcare in our community."

According to BCBSNC, CHC will remain an in-network hospital for BCBSNC customers through Jan. 31, 2016. After that date, in-network coverage for BCBSNC customers at the hospital will be limited to emergency care, services that qualify for BCBSNC's Continuity of Care program, and care that is not reasonably available at other area facilities.

The Carteret County Commissioners also released a statement on the situation.

"As Commissioners and citizens of Carteret County, we understand the impact of the potential loss of the contract between Carteret Health Care ("CHC") and Blue Cross and Blue Shield of North Carolina ("BCBSNC").
"Carteret Health Care is a North Carolina nonprofit corporation, whose operations and decisions are made by the Hospital's Management Team and their Board of Directors. The Commissioners of Carteret County, nor the Carteret County Government staff, has involvement in the negotiation process of any of its contracts; the current contract negotiations are strictly between the Hospital and Blue Cross.
"We are hopeful that CHC and BCBSNC will be able to negotiate an acceptable contract for both parties that will enable the Hospital to remain an in-network facility, and continue to provide the excellent level of care to its patients and the entire Carteret County community prior to the contract's projected end date of February 1, 2016."

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