published Thursday, August 9th, 2012

Some employees get chance to change insurers because of BlueCross-Memorial fight

Aerial of BlueCross BlueShield of Tennessee headquarters in Chattanooga
Aerial of BlueCross BlueShield of Tennessee headquarters in Chattanooga
Photo by Dan Henry /Chattanooga Times Free Press.
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At least one Hamilton County employer is offering employees the chance to switch to another insurance plan as the stand-off between Memorial Health Care System and BlueCross drags into its second week.

Other employers urged the two companies to find a resolution, saying employees are being hurt by the deadlock.

Officials with Hamilton County Schools and Chattanooga said they have heard from numerous employees who use Memorial and are concerned about the issue.

Hamilton County Schools officials said their 5,000 employees have the option to switch from BlueCross BlueShield of Tennessee to Cigna, a more restrictive plan that includes Memorial. So far few have made the switch, but they can do so until the end of August, said Krista Torrance, employee benefits manager for the school system.

"People are hedging their bets right now," Torrance said. "We have heard a lot of concern, but Memorial has guaranteed to honor in-network costs."

About 55 percent of school employees have BlueCross and 45 percent use Cigna, she said.

The contract between Memorial and BlueCross expired July 31. Memorial says BlueCross refuses to consider the changing health care market and give larger reimbursements; BlueCross says Memorial wants to negotiate a contract that doesn't acknowledge this is not the system of the 1990s.

The withdrawal does not affect doctors affiliated with Memorial.

Madeline Green, director of risk management and insurance for the city of Chattanooga, said they also are assuring employees that they will not need to pay more under Memorial's promise.

Green said the city may eventually consider other insurance plans, but that's not an option anytime soon. Right now, they are urging the two sides to negotiate a new contract.

"The bottom line is our employees need to be taken care of," Green said. "But we really want to work with BlueCross. It's taxpayers dollars that go directly toward this. There is a fear if BlueCross were to pay Memorial this increase, what is to keep other providers from asking for large increases?"

Chattanooga and school system officials said they have heard from numerous employees who use Memorial and are concerned about the issue. About 55 percent of school employees have BlueCross and 45 percent use Cigna, Torrance said.

Despite the assurances from Memorial, an independent health insurance broker recommended BlueCross members get hospital costs in writing if they plan to go to Memorial.

"You could be in for a big surprise," said David Wills, a broker with D.B. Wills and Company. "What we're telling people is ... make sure if you go to Memorial, you get in writing upfront exactly what they are going to charge you -- period -- before you have it done. Not after the fact."

Based on the information that has been released so far from both Memorial and BlueCross, it is not clear exactly how patients will be affected, Wills said. Even the information that has been given has changed almost every day, he said.

On Wednesday, Memorial officials repeated assurances they will not charge patients out-of-network costs.

"Patients will not pay higher out-of-network deductibles or co-insurance to use Memorial facilities," Memorial spokeswoman Lisa McCluskey wrote in an email. "Memorial will write off any out-of-network penalties for Memorial services."

Even if Memorial does keep that promise, Wills said there are other costs that patients most likely do not realize.

For example, an out-of-network and an in-network deductible are calculated differently. A patient who goes to Memorial and pays the out-of-network deductible would have to pay an in-network deductible if they later go to Erlanger, he said.

The city offers two BlueCross plans, both network "S" and "P." This is the first year the city has offered "S" and the "vast majority" of their 2,100 employees use network "P," Green said. Before going out of network, Memorial was only in-network in the "P" plan.

Green said the city is looking at temporary options and working with both BlueCross and Memorial to make sure employees will not pay higher costs.

BlueCross has offered employers the opportunity to allow their employees to join network "S," which is a lower-cost network.

"We are aware that many of your employees and our members in the Chattanooga area chose Network 'P' because it includes Memorial," BlueCross told their members in a recent letter which provided details about how employers can make the switch.

Wills said he hopes more information will become available so employers and employees can make the best choices. In the end, it is likely the two will come to an agreement, but no one knows how long that may be.

"Unfortunately, this isn't a game," he said. "It's real life. Both have drawn lines in the sand, and it's hard to negotiate when you've done that."

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about Mariann Martin...

Mariann Martin covers healthcare in Chattanooga and the surrounding region. She joined the Times Free Press in February 2011, after covering crime and courts for the Jackson (Tenn.) Sun for two years. Mariann was born in Indiana, but grew up in Pennsylvania, Tennessee and Belize. She graduated from Union University in 2005 with degrees in English and history and has master’s degrees in international relations and history from the University of Toronto. While attending Union, ...

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