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Saint Francis, Blue Cross Blue Shield give differing views of negotiation break down

Muskogee Medical Center Authority votes to maintain lease agreement with Saint Francis
Posted at 4:25 PM, May 05, 2021
and last updated 2021-05-07 17:56:18-04

TULSA, Okla. — Saint Francis Health System and Blue Cross and Blue Shield of Oklahoma are parting ways after failing to come to an agreement during contract negotiations.

The current contract between the two expired on April 30.

BCBSOK said they were unable to reach an agreement that would protect its members from future cost increases as Saint Francis expands. BCBSOK is currently in a 90-day transition period. Meaning, BCBSOK members will still have in-network access to Saint Francis locations, clinics, and physicians until July 29.

Saint Francis Health System said negotiations started with BCBSOK January 1, 2021 and a deal was initially agreed upon, but BCBSOK later sent updated terms that Saint Francis could not agree to sign.

"There are countless examples across the country of patients being put in the middle of insurance company/health system negotiations. This is a situation we have wanted to avoid from day one," said Jake Henry Jr., President and Chief Executive Officer of Saint Francis Health System.

Throughout the process, the goal has been for both parties to come to an agreement that will best serve the patients enrolled in a BCBS plan by not only ensuring they have access to the state's most comprehensive physician network but also ensuring that the medical professionals in that network are appropriately reimbursed for the care they provide.

Members who are currently undergoing treatment at Saint Francis for a disability, acute condition, a life-threatening illness, or are in their second trimester of pregnancy may still qualify for in-network rates through Continuity of Care after July 29. To see if you are eligible, call the BCBSOK customer service number on the back of your insurance card.

BCBSOK said it's reaching out to about 59,000 subscriber households to let them know about the upcoming change. Lisa Robertson, partner and account manager at Courtside Benefits Group, said many of those members are in rural communities.

“Now, all of a sudden, we have a hospital that is not going to be in their network," she said. "Not only not in their network, but that may be the only clinic in their town, which means they have to drive further, get new providers, and completely disrupt their life.”

Oklahoma Insurance Commissioner Glen Mulready said all members affected should reach out to their insurance agent or broker and your company to find out what’s next.

“Educate yourself on what’s your plan currently has, what that change would mean to you, what’s that difference going in-network versus out of network," Mulready said.

BCBSOK said a majority of members have plans that provide coverage for out-of-network benefits, meaning they could continue to receive care from a Saint Francis location. But, both Mulready and Robertson, warn there could be a big financial impact from paying that out-of-network cost.

"In a small group plan, the out-of-network has an unlimited max," Robertson said. "What that means is if my bill is $200,000, that’s what I’m on the hook for. There is no cap to the out-of-pocket max.”

Mulready and Robertson also said to let both sides know how this separation will affect you.

“I would hope, if I were talking to Saint Francis and I were talking to Blue Cross Blue Shield, I would hope they look at the thousands of members who rely on both of them and find a way to reach the middle," Robertson said.

In case of an emergency, BCBSOK said members should go to the nearest emergency facility. Emergency services are covered at the in-network cost.

Saint Francis President and CEO said he's still willing to sign the original agreement.

I am still ready to sign the contract I agreed to that afternoon. Saint Francis Health System is ready to put the issue to rest and move forward.” Henry added, “We’ve all been through a lot this past year. Our patients, healthcare workers and the community have had enough to worry about related to their health and wellness. We’re just a few signatures away from being able to put this behind us… my pen is ready.

BCBSOK released a statement responding to the Saint Francis statement about negotiations.

We want to come to an agreement with Saint Francis. We tried for many months with that goal in mind, but we work for our members. It’s their premium dollars that they’ve entrusted us with. We cannot sign an agreement that could put them in financial harm. When Saint Francis comes to the table with a reasonable agreement that ensures our members are protected from unexpected future costs, we’ll sign.

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