NC's Mission Health System Pulls Out of Blue Cross

July 07, 2017

Mission Health System in Asheville, North Carolina recently announced that it will be pulling out of the Blue Cross and Blue Shield of NC insurance network effective October 5, 2017.

Here's what Blue Cross has to say about it.

Here's what Mission Health has to say about it.


Why it's happening

For the last six months Mission Health, which currently serves 18 of the state's westernmost counties, has been negotiating with BCBSNC to come to an agreement on BCBSNC's effective payment rate reductions to the health system. Charles Ayscue, Mission Health's Senior Vice President and CFO, said the attempts to reach an agreement were based on a need to raise revenue for the health system, which has already made significant cost reductions. 

"BCBSNC’s latest proposal imposes effective payment rate reductions to our health system at a time when modest annual increases are more important than they have ever been," he said. "Even if we earn every dollar of pay for performance incentives offered by BCBSNC, we could at best get back to zero for three straight years. It’s simply impossible to keep up with rising medical supply, pharmaceutical, and other operating costs, let alone provide future wage increases to our fantastic team members without appropriate annual adjustments to our payment rates from BCBSNC in the coming years.”

Mission Health said "this decision was not made lightly" and that it was a matter of the health system's long-term financial and operational sustainability.  

Mark Werner, Vice President of Provider Network at BCBSNC, said that they are disappointed that Mission Health plans to cancel its contract rather than work toward a solution "to keep healthcare and health insurance as affordable as possible for (people) in Western North Carolina." 

According to BCBSNC, Blue Cross customers already pay more for care at Mission Health compared to several other health systems. BCBSNC also attests that Mission Health is among the most expensive facilities for common inpatient procedures like newborn deliveries, knee replacements, chest x-rays, and CT scans. They argue that high costs directly contribute to higher premiums and out-of-pocket costs for all North Carolinians, which is why they proposed payment rate reductions for the Mission Health system.

What this could mean for you

All Mission Health hospitals, outpatient facilities and most physicians will be out-of-network beginning October 5. Some Mission Health physicians within the health system will remain in-network until March 2, 2018, but yours could be out-of-network earlier than that, so check with your doctor!

Mission Health patients who are insured by Blue Cross Blue Shield will be forced to seek healthcare elsewhere or pay out-of-pocket expenses. 

In the meantime, if you're one of the North Carolinians this news affects, make sure you get clear information on what this means for you, your family, and your wallet. 

No matter who you're insured by or what health system you visit, higher hospital costs are absorbed by everyone in the form of higher premiums. Healthcare is already expensive. One way to lower costs is to roll back state-based mandates that drive up the cost of healthcare for everyone. Want to fight them? Join us.

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