It's a health care game of chicken that frankly occurs too often in Chattanooga.
We're talking about the contract dispute between CHI Memorial Health Care System and insurer BlueCross BlueShield of Tennessee over what the hospital and its doctors are paid.
If the two sides cannot reach an agreement by Sept. 8, the health system's facilities, physicians and services will be out-of-network for patients with either commercial or BlueAdvantage (Medicare Advantage) plans, with the Chattanooga Heart Institute becoming out-of-network Oct. 1.
Out-of-network means higher costs for patients.
Talks between the two have been going on, depending on the source, for either six or eight months. But the apparent stalemate has reached the point where both sides have reached out to patients and subscribers to apprise them of the upcoming deadline. And thousands of patients and subscribers are getting nervous.
We're astounded that with so much on the line and in the time in which negotiations between adults have occurred that nothing has been settled.
Tens of thousands are in the middle in the dispute, with many wondering to whom they'll go for their next doctor's visit and what they'll do if they need the services of a hospital. And it's not like they don't have enough to worry about with a global pandemic.
Unfortunately, though, Chattanooga's health care consumers have been here before.
Times Free Press archives show CHI Memorial had contract showdowns with UnitedHealthcare in 2012 and 2016, and with BCBS in 2012, and that Parkridge Hospital and BCBS had a contract dispute in 2003. The 2003 article also mentioned a dispute between the then-Erlanger Medical Center and BCBS a decade earlier.
In both 2012 CHI Memorial disputes, the contracts with the insurers did expire, and some patients were forced to make new health care choices before new agreements were reached. With UnitedHealthcare, the impasse was 10 days; with BCBS, it was nearly a month.
In the 2016 disagreement, patients were on their own for more than three weeks before CHI Memorial and UnitedHealthcare signed a new pact.
The contract problems, to put it simply, come down to the hospitals wanting to get the highest reimbursement rates they can for physicians and the care they give, or at least on par with other hospitals, and the insurers wanting to keep increases down to prevent more costly health insurance.
We simply "can't continue to pay providers ever higher rates when our customers are asking us to hold the line on costs," then-BCBS Senior Vice President Ron Harr put it during the insurer's contract standoff with Parkridge in 2003.
Nine years later, then-incoming BCBS CEO Bill Gracey said CHI Memorial was simply "dialing for dollars" and later called their failed negotiations "troubling, frustrating and baffling."
On the hospitals' side, then-Parkridge Hospital President Niels Vernegaard accused BCBS in 2003 of saying "they don't want you." And in 2012, then-CHI Memorial spokeswoman Lisa McCluskey said the hospital only wanted BCBS to pay it the rates it paid Parkridge. A Memorial spokesperson, discussing the 2016 dispute with UnitedHealthcare, said the "inability to finalize a contract by the expiration date is a direct result of UnitedHealthcare's failure to accurately and fairly reimburse CHI Memorial for services and care."
And so it goes.
This year's back and forth sounds like the same record.
In a letter to physicians, CHI Memorial CEO Janelle Reilly said the health system "has been negotiating in good faith" with BCBS. Meanwhile, BlueCross officials said they were "surprised" and "disappointed" CHI Memorial initiated a contract termination with only a 60-day notice, before their contract was set to expire. The insurer's Marc Barclay, vice president of provider network contracting, said "we are disappointed to be in this position."
Since consumer health care plans seem to get more complicated every year, some individual BCBS users with certain circumstances, and in specific instances, could be covered, while most will not, if the contract dispute goes past Sept. 8. We would encourage patients to check with their doctors and insurance company before making plans for a doctor or hospital visit after that date.
However, we believe, at the very least, both BCBS and CHI Memorial should be using social and traditional media to keep reassuring their customers that they are negotiating, that they have every intention of solving the problem before the deadline and that their clients come first.
We don't doubt for a moment that negotiating such mammoth deals is complicated and tedious, but the fact that Chattanooga area health care consumers have to put up with this kind of game of chicken every few years is frustrating.
Have both sides moved from their original positions? Could an arbitrator help? Might negotiations have begun earlier, especially given the local history of such disputes?
We hope clearer heads will prevail soon and not drive this disagreement past its September deadline. Any year it happens is a shame; that it has occurred during a global pandemic is inconceivable.