ASHEVILLE — Mission Health President and CEO Dr. Ron Paulus didn't mince words about Blue Cross Blue Shield of North Carolina in an email to employees last week, calling the insurance provider "the most unethical, bullying foe that I have ever faced."

"When leaders from across North Carolina and beyond called to 'warn me about what Blue Cross would do,' I listened carefully but was skeptical," Paulus wrote in the Oct. 4 email to about 60 senior leaders close to an ongoing contract negotiation that led the insurance provider to be dropped by the health care provider.

The email, obtained by the Citizen-Times, was sent shortly after 8 on the night before the Oct. 5 ending of a contractual agreement between the two sides. Its end means about 260,000 people in Western North Carolina who are insured by Blue Cross would, in many cases, have to pay "out-of-network" rates to receive care at Mission facilities.

Paulus, in a little more than 600 words, accuses Blue Cross of lying to its clients, remarking, "I didn’t think that was possible from a multibillion dollar company, but alas it was and it is."

Mission confirmed the authenticity of Paulus' email this week.

In a phone conversation Wednesday, Paulus called it a "private email" that was not intended for Blue Cross or the public in general.

"It was a message to core team members that had been through the equivalent of a battle," he said, "and who I felt needed for me to be clear of my support for them, my willingness to stand with them and my willingness to sacrifice or be sacrificed for them."

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In the email, he also said that while patients and staffers will be "scared and irrational," Mission's senior leaders need to set the example by remaining "calm, constantly compassionate, and above all, absolutely patient focused."

"Unlike Blue Cross, we don’t 'do this kind of dirty work for a living,'" he wrote. "We care for people. We heal them. We comfort them when we can’t heal them and above all, we respect them always."

The email is separate of one Paulus sent the following day to the all of Mission's nearly 12,000 employees, where he calls the situation "sad and tragic" but ultimately unsurprising "given that they have literally been unwilling to even speak with us about a new contract."

It is the latest in what has been a tense few months for the two sides since Mission notified Blue Cross on July 5 it planned to terminate its contract.

Mission said negotiations with Blue Cross had not yielded an acceptable agreement. The health care system expressed concerns that it would not be able to care for people at current Blue Cross rates indefinitely, given the rising costs of labor, equipment and medications.

BCBSNC says its customers are demanding it slow the rise of insurance and health care costs. It argues Mission should accept a proposed offer that includes no increase in reimbursement for the first year of a contract that likely would run two or three years.

However, Blue Cross said repeatedly it refused to negotiate with Mission unless the health system rescinded its termination notice. It could lead to confusion, Blue Cross argued, if it continued to negotiate with a provider while also prepping people to find different medical practices in the event an agreement was not reached.

Few specifics have been shared by either side on contract negotiations.

In a statement to the Citizen-Times issued Tuesday, Blue Cross NC said it stands ready to partner with Mission on an agreement that supports "affordable, quality health care for Western North Carolina."

"We are approaching any meetings with Mission Health as an opportunity to work together for the people of Western North Carolina," the insurance provider said, "and despite these comments we hope that Mission Health will do the same.

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Both sides have expressed interest in negotiating a new deal, though it remains unclear if or when that would happen.

Last month, Paulus predicted it would be probably next year before the two sides can work out a contract. In his Oct. 4 email, he told employees he's at peace "whether tomorrow and the weeks to come turns out to be a bloody slaughter like storming the beaches of Normandy or precision warfare like the first Persian Gulf war."

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"I’m at peace because our focus, intent and actions have been true and honorable, and because I will have done it with you," he wrote.

Mark Werner, head of network management for Blue Cross NC, told the Citizen-Times in September it would take several weeks to re-establish reimbursement arrangements when a new contract is in place.

"After Oct. 5, we're ready to resume negotiations. ... It'll be a clean slate," Werner said.