NEBRASKA CITY – Officials announced this week that the Nebraska City Medical Clinic remains in-network for Blue Cross Blue Shield patients.
CHI Health St. Mary's, however, remains out-of-network.
"That was good news for us and good news for Nebraska City," said Dan Kelly, President of CHI Health St. Mary’s. "We felt very strongly that we were out-of-network… It really took a long time to get pinned down. Based on our structure here, we under the assumption that we were all out-of-network."
Kelly said this revelation came after calls from area clients to the BCBS customer service line prompted deeper investigation.
Apparently, The Physician Network, which operates within the clinic, has an "individual contract" with BCBS, allowing doctors to continue to accept patients on an in-network basis.
"Even though that our local group is legally part of St. Mary's, we are still affiliated with [The Physician Network]," Kelly said.
The ongoing dispute between CHI Health and BCBS was the result of failed contract negotiations, which resulted in CHI Health facilities going out-of-network for BCBS patients on Sept. 1. As of Sept. 11, negotiations had not resumed as initially anticipated.
"There's no word as of this juncture," Kelly said. "It's going to be a constantly evolving situation, and we're working with patients all the time to make it as painless as possible."
In the meantime, CHI Health has pledged to continue working with its clients.
"What we have done is restructured things at the clinic so the patients aren't overly penalized for a battle that really was not of their choosing," Kelly said in a previous report. "The average visit won't cost a whole lot more than it did when they were in-network. We're basically going to be charging the in-network price."
According to BCBS of Nebraska president and CEO Steven S. Martin, the failed contract negotiations were the result of CHI's high costs.
"CHI’s Alegent Creighton Health network of hospitals and physicians (now CHI Health) charges our members up to 30 percent more than other providers in Omaha for the same services," Martin wrote in an op-ed piece for the Omaha World-Herald. "...We found that our members would have saved over $60 million last year if they had received their care at non-CHI systems."
According to a letter from CHI Health CEO Dr. Cliff Robertson released prior to the Aug. 31 deadline, CHI "fundamentally" disagrees with the way BCBS "intends to maintain and lower costs, with no concern for quality."
"On Aug. 22, UniNet offered Blue Cross a contract that would offer patients a health plan that works to lower costs by keeping their members healthy and control chronic health conditions. Blue Cross turned down that offer, our fourth full-length proposal, and did not provide a counter offer," the letter stated. "They posted UniNet's offer on their website, but only chose to share half of it – they failed to post the portion that included a savings of over $55 million over the next two years."