Key Takeaways
- CHI Memorial terminated our agreement early, even though we've been in negotiations since late 2020.
- We've made two fair and reasonable offers to CHI Memorial, which they've rejected.
- We're still trying to reach a new agreement and prevent a disruption for our members.
Right here in our hometown of Chattanooga, we have three comprehensive health systems — along with many primary care and specialty providers — that offer high-quality care to our members.
Unfortunately, our members’ choices may soon be more limited. Here’s what you need to know.
CHI Memorial terminated our agreement early
CHI Memorial notified us in early July that their facilities and affiliated providers will leave our networks effective Sept. 8, 2021. This will affect members who get coverage at work, have an Individual/Marketplace plan or have one of our Medicare Advantage plans.
We were surprised and disappointed.
We value the high-quality health care services that CHI Memorial provides to the Chattanooga community, and we want to continue our longstanding relationship. In fact, we’ve been in negotiations since late 2020 because we want to preserve our members’ access to care and avoid a disruption. And we are still working to reach a new agreement.
Why members could face higher costs starting Sept. 8
If we don’t reach a new agreement, CHI Memorial will be out-of-network starting Sept. 8 because they terminated our contract. They’ve stated their withdrawal from our networks won’t affect member costs, but we don’t believe that’s accurate.
That’s because when a provider is out-of-network, it changes how claims are processed. Here’s how that works:
- If you have an employer-based or Individual/Marketplace plan, we are obligated to apply out-of-network (OON) benefits if you get services from an OON provider.
- That means a claim would apply to your separate OON deductible, rather than your in-network (INN) deductible.
- If you have a high-deductible plan and have already met your INN deductible, you might be expecting to be responsible only for your portion of the claim cost (sometimes called “coinsurance” or “cost-share”), which is often 20%. But you’d actually be responsible for the full cost if you haven’t met that separate OON deductible.
- If you have a plan with copays, an in-network $20 copay might become 40% coinsurance after the out-of-network deductible, and so on.
We’ll help members find new providers if necessary
If CHI Memorial and its affiliated providers do leave our networks in September, we are committed to coordinating care for our members and helping them find alternate providers for the services they need.
You can still choose to go to a CHI Memorial facility or provider, but as noted above, your claims would be based on your out-of-network benefits. You can search for a new provider using the Find Care tool on BCBST.com, or you can call the number on the back of your member ID card to get personal assistance. We maintain an excellent network of providers where you and your family can receive care.
If you have ongoing services scheduled at a CHI Memorial facility, a nurse from BlueCross will work with you and help you transition care to an in-network provider. Our goal is to ensure you experience no disruptions in care.
Under our Continuity of Care policy, some CHI Memorial patients may be granted in-network status. Patients who may qualify for this status include:
- Patients whose practitioner/facility are terminated from the network during treatment, i.e., chemotherapy or radiation patients
- Patients with complex medical and/or behavioral health conditions
Why we have to hold the line on costs
As advocates for our members, we’ve always focused on affordability. The rates we pay providers for their services directly affect what we have to charge our members for coverage and what businesses pay for their employees’ care.
We work hard to manage the costs of care for our members, and our own operating costs. And we’re transparent about our financial stewardship. In 2020, 86 cents from every dollar we charged in premiums went to pay for medical services. After operating costs and taxes, we kept just two cents in net income.
We also know that in the COVID-19 era, affordability matters more than ever to the businesses who provide coverage for their employees, and to each one of our members. That’s why we can’t agree to the significant cost increases CHI Memorial has requested.
We hope we’ll be able to reach a new agreement and keep these providers in our networks.
In the meantime, we’ll keep you updated on our negotiations at BCBSTinfo.com.
Todd leads the team managing our provider agreements, operations, data, and innovation that impact provider reimbursement and relationships across our commercial, Medicaid and Medicare line of business. He also leads the team managing and operating our 4-STAR quality rated Medicare Advantage plans and our Medicare Supplement products.