11/06/13 — Wayne Memorial Hospital, Blue Cross and Blue Shield are still talking

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Wayne Memorial Hospital, Blue Cross and Blue Shield are still talking

By Matthew Whittle
Published in News on November 6, 2013 1:46 PM

Contract negotiations between Wayne Memorial Hospital and Blue Cross and Blue Shield of North Carolina are continuing, even as the insurance company sent letters to its customers Tuesday explaining what it will mean if the hospital is pushed out of network on Dec. 5.

The letters, dated Monday, were sent to customers who either recently received or who are scheduled to receive care at Wayne Memorial.

"We are required to send letters informing them of their options for transferring their care or remaining at Wayne Memorial 30 days before the contract ends. We want to help them get the care they need and answer any questions," Blue Cross spokesman Lew Borman said Tuesday.

But with a month to go until the Dec. 4 deadline, both sides are hopeful they can come to an agreement, though Borman indicated that Blue Cross is frustrated with the pace of the renewed negotiations.

"There hasn't been much progress toward a new deal," he said. "The hospital seems to be operating on a different time frame than we are. They don't seem to have the same urgency to get this done."

The negotiations resumed late last week after WMH CEO Bill Paugh and BCBSNC CEO Brad Wilson sat down on Oct. 28 and agreed the two sides would return to the table to try to end the impasse that had lasted since Sept. 5.

Paugh explained Tuesday that after his conversation with Wilson, the two sides immediately began talking again, but acknowledged that negotiations did not start in earnest until Thursday. And unfortunately, he said, they weren't able to come to an agreement fast enough to prevent the letters from going in the mail.

Still, he said, the process is ongoing.

"We're continuing to negotiate. We're negotiating today," Paugh said.

However, Borman said, despite an offer from Blue Cross to send a negotiating team down to Goldsboro, the bulk of the discussions are being held via telephone and email -- at the request of the hospital.

Heading up the negotiations for the hospital is chief financial officer Becky Craig.

"They're talking. They're speaking to each other," Paugh said. "It's not because they don't want to sit and look at each other, it's that there would be a lot of wasted time to have them sitting face to face.

"The issue is just the complexity of this 41-page contract, and when we talk about something, we really need to be able to run it through our financial models. We're talking about the long-term financial health and future of our hospital, and we've got to make sure we don't make a mistake."

If, he said, they were simply looking at one issue or a single provision -- such as the one regarding the relationship between Wayne Memorial's basic outpatient charges and Blue Cross' allowable rates that has been at the heart of the public discussions -- then perhaps face-to-face discussions would be appropriate. But, he continued, when he and Wilson agreed to restart the negotiations, they agreed to go back and take another look at the entire contract.

"It's not about a single provision. We're talking about all the provisions. It's not a single issue. Everything is interdependent," Paugh said. "We're going line by line, and that doesn't lend itself to sitting down and looking at somebody and doing this on the fly. There's a lot going on behind the scenes.

"This whole thing is open for negotiation."

Again, though, Borman said Blue Cross has a slightly different interpretation of the process, indicating that the insurance company is focused not on the whole contract but on several specific provisions, primarily the one regarding the hospital's rates.

"It's a small handful of issues, and they're significant," Borman said. "We continue to tell them we cannot accept a provision that allows rates to be increased unilaterally, and we've suggested a number of options there."

Paugh, though, said he believes progress is being made.

"It's really hard to talk about any one part of it until all the issues are resolved, but I think we're making progress," Paugh said. "I feel good. We're sitting at the table and that's where we'll stay."

But just in case that agreement is not reached by Dec. 4, the letters explained that the termination of the contract between Wayne Memorial and Blue Cross:

* Will not affect the network status of providers affiliated with Wayne Memorial

* Will still allow customers to use Wayne Memorial for emergency services at in-network benefit levels without prior authorization

* Will cause other, non-emergency services to either not be covered or covered at lower out-of-network benefit levels, depending on specific plans -- the most important piece of information in the letter, Borman said.

"In case of an emergency, people should go to the nearest hospital. It's critical for them to understand that," he said.

The letters also explained the conditions for continuity of care coverage, which allows customers to receive care from an out-of-network provider for an acute illness, a chronic illness or condition, a terminal illness or a pregnancy at the in-network benefit level for a short time period.

Requests for continuity of care coverage must be made within 45 days of Nov. 4, and will be handled on a case-by-case basis by Blue Cross.