ASHEVILLE – Understanding how much your health insurance will pay for what care from which provider is hard enough under normal circumstances.

The end Thursday of a contract between Blue Cross Blue Shield of North Carolina and Mission Health that determines how much the insurer pays the medical system for care adds yet another level of complexity.

The dispute between the two will disrupt relationships between physicians and patients across Western North Carolina in coming days and weeks.

Over the longer term, when, how and whether the argument is settled will have a major impact on how much WNC employers and residents pay for health insurance and significantly influence the finances of the region's largest private employer and largest health care provider.

MORE:Boyle: Mission and Blue Cross are just hurting regular people.

Following are answers to common questions about the dispute.

Question: How will this affect me?

Answer: People insured by companies besides Blue Cross NC or who have no insurance will see no change. The same is true for those insured by Blue Cross NC who get their health care from providers that Mission does not own.

However, Mission has 12,000 employees, about a fifth of physicians practicing in WNC work for the system and it has seven hospitals in the region. Blue Cross NC insures about 260,000 mountain residents. So, the relationship between the two affects a lot of people.

People insured by Blue Cross NC can still get care from Mission and the doctors who work for it, but they may have to pay more. Until a new contract is signed, "out-of-network" rates will apply for Blue Cross NC policyholders when they get care from Mission providers. That typically means policyholders will pay higher co-payments and face higher deductibles. Details vary by policy.

Q: What do I do if I have a Blue Cross NC insurance and I have a heart attack?

A: Go to the emergency room right away and don't worry about your insurance. Emergency room care is always considered "in network," so your share of the cost will be the same whether you go to a Mission hospital or a competitor.

Q: My doctor works for Mission or I need to have a procedure done at a Mission hospital. What are my options?

A: If you are not insured by Blue Cross NC, everything stays the same.

If you have Blue Cross NC insurance, you can switch to another physician or hospital in the Blue Cross NC network not owned by Mission to continue to pay in-network rates for your care.

You may be able to switch to another insurer. Mission has agreements with Aetna and Cigna and other insurance companies. However, if you get insurance through your job, your ability to change insurers will depend on what options your employer offers. Also, Blue Cross NC is the only company offering health insurance via the Affordable Care Act in WNC.

You can continue to see your current doctor or continue with plans for the procedure. That means you are subject to paying higher out-of-network rates, although you can take advantage of a discount plan Mission is offering those insured by Blue Cross NC.

Mission said in August it will give "a generous, prompt payment discount after taking into account the patient's personal financial responsibility." To get the discount, patients must send Mission the reimbursement check they get from Blue Cross NC and the accompanying explanation of benefits – a statement from an insurer saying how much they paid and for what – within 10 days.

Q: I want to switch doctors or have my surgery done somewhere else. Do other health care providers have enough room to take care of me?

A: It depends on where you live and may involve some extra travel.

Park Ridge Health, based in Fletcher, says many of its physicians in Buncombe County are accepting new patients, and Hendersonville-based Pardee UNC Health Care says its physician practices and other health care facilities also expect to treat new patients. Blue Cross NC says there is generally enough capacity in the regional health care system to accommodate patients looking for new providers.

There are exceptions. Three-quarters of the physicians based in McDowell County work for Mission and all but one of the doctors based in Graham County do. It is unlikely that the remaining doctors could handle the load if all of Mission's patients switched providers. There may be other areas with similar problems.

There are some procedures and specialties for which Mission is the only provider in the region or employs the vast number of providers. A Mission official estimated that only a handful of cardiologists in WNC work for anyone other than Mission.

State rules limit how far afield an insurer can require a patient to go to get care. Blue Cross NC says it is working with patients who need help locating providers. In some cases, notably many pregnant women and cancer patients, it says its customers will be able to continue seeing their current providers without paying more.

Q: What are Blue Cross NC and Mission arguing about?

A: At issue are the rates at which Blue Cross NC pays Mission for care that Mission gives people with Blue Cross NC insurance.

Blue Cross NC says its customers are demanding that it slow the rise of insurance and health care costs. It says Mission should accept the offer of no increase in reimbursement for the first year of a contract that would probably run two or three years as 40 or so of the state's 110 hospitals have done.

Mission says the amounts it pays for drugs, medical devices, labor and other things it must buy keep going up and it has already made its operations much more efficient in recent years. It says it must get a rate increase to protect its long-term future because a higher percentage of its patients are covered by Medicare and Medicaid – which provide reimbursements that do not cover the entire cost of care – than at other comparable large health systems in the state.

Neither side has discussed specifics of their offers in contract negotiations, except for Blue Cross NC's statement that is offering no increase for the first year.

Q: If Mission agrees to no rate increase, does that mean my insurance rates won't go up?

A: No. A Blue Cross NC official said last week that other costs it covers continue to rise and that the aging population means people need more care, so its rates would continue to rise.

Q: Why haven't they worked this out already?

A: It is difficult to know all of the reasons several months of confidential negotiations did not yield an agreement. What is clear is that they stopped when Mission gave Blue Cross NC a notice of termination of the existing contract July 5.

Mission said that if it had not taken that step, the contract would require it to keep providing care at current rates indefinitely, something it says it cannot afford to do. Blue Cross NC says it will not negotiate with Mission or any other provider after it has received a termination notice.

Blue Cross NC says once it receives such a notice, it has to focus on getting patients connected to new physicians and continuing negotiations would interfere with that process. Mission says there is no reason the two sides could not keep talking after it gave notice, and one of its officials called Blue Cross NC's policy of no talks "childish."

Q: What are the prospects for an agreement now?

A: Blue Cross NC says it is willing to negotiate with Mission once the existing contract expires Thursday. Mission says it wants to talk, too. We don't know when or whether that will happen.

Even if negotiations resume right away, it will probably take some time before Mission would be part of Blue Cross NC's network again.

Dr. Ron Paulus, president and CEO at Mission, predicted recently that it would probably be next year before the two sides can work out a new contract.

Mark Werner, head of network management for Blue Cross NC, said it would take a few weeks to re-establish reimbursement arrangements once a contract is in place.

More information

Parties involved in the Blue Cross NC/Mission Health dispute have set up websites and other means to get their side of the story to the public and to help people make alternative arrangements to get care.

• Information from Blue Cross NC is available via www.bcbsnc.com/missionhealth or by calling 1-800-446-8053. Those insured by Blue Cross NC can also call the number on the back of their insurance card.

• Mission has set up a website with information on the dispute, www.standwithmission.org, and a telephone number people can call with questions: 828-417-0480.