Representatives from Mission Health and Blue Cross and Blue Shield of North Carolina dug in their heels during a presentation in front of the Buncombe County Board of Commissioners on Tuesday. The health care system and insurance provider are at loggerheads over a contract. And while representatives from both organizations said they are willing to negotiate, neither made tangible steps toward committing to do so during Tuesday’s forum.

Earlier this month, Mission publicly stated it canceled its contract with BCBS, a move that would affect more than 4,000 Buncombe County employees, retirees and their dependents. Further, it could put a strain on the county’s three federally qualified health centers, as some 22,000 county residents are on the Affordable Care Act, and BCBS is the county’s only provider in Western North Carolina.

Symptoms of trouble

“Let’s sit face-to-face and work through this. We will come back to the table when termination is rescinded,” Patrick Brady, BCBS director of national accounts, said of Mission Health’s contract termination.

“Mission Health was at the table for over a year with good faith, but [the contract] was not resolved,” countered Jill Hoggard-Green, Mission’s chief operating officer.

And while both parties repeatedly said they would like to negotiate, it became clear to county commissioners there was little progress being made ahead of the Oct. 5 deadline, the date the existing contract will officially dissolve.

In the meantime, all BCBS enrollees will have the same coverage and facilities available.

“Why are we here? I’m here to represent our customers. The issue at hand is that our customers cannot continue to bear unreasonable medical costs year after year. We have an obligation to make sure we provide affordable products,” said Brady while outlining BCBS’s position on why a new contract is not in the works.

“Mission has historically enjoyed guaranteed increases. What we are asking for at this point is those increases be tied to quality and outcomes, and that any increase is based on benefit to members in terms of high-quality care.”

Meanwhile, Mission says it’s already scaled back expenditures to the tune of $240 million over the past five years using cost-cutting methods. Hoggard-Green said the automatically renewed contract with BCBS doesn’t give Mission adequate ability to negotiate and institutes a zero percent increase for Mission. “If you go out of network, they pay the beneficiary directly and joke the provider never sees those resources,” she said, identifying as another sticking point.

Many of these issues have played out in public relation campaigns over the past few weeks, but the county is on the clock, and commissioners seem sick of it.

“The timing is horrible at best,” stated Commissioner Joe Belcher. “It is unacceptable for [Mission] to give the termination status. Y’all have to negotiate. That’s your job. You provide health care. This contract has got to be fixed.”

“We appreciate your counsel. We want to be back in negotiations,” said Hoggard-Green, with Belcher immediately following up: “You need to show us.”

“I’m sorry I didn’t wear my short pants because we are sick and tired of hearing how much [Mission] cares for us. We know that,” said Commissioner Al Whitesides, indirectly noting shorts would help with what he believed they were wading through.

“Now is the time to sit down and show us you practice what you preach. If you care about Buncombe County, let’s sit down and do something. You don’t need a mediator for that, just get rid of the legal departments and do it.”

Commissioners pressed Mission as to what percent the system wants to see in the upcoming contract, a number Hoggard-Green noted she wasn’t legally allowed to reveal. “There is a percentage, and BCBS is aware of it. It’s a percentage increase from what they presently have. I don’t believe we are allowed to talk about that due to contract negotiations,” she said.

Coverage triage

As the talks pivoted to what will happen to those on BCBS plans, Brady said: “They need to start thinking about those hard questions now. If someone calls us, we will give information on other options and continuity of care. What we don’t want is the surprise of someone walking through the door and finding they are out of network.” He also noted that regardless of coverage, people should always use the closest health care facility in an emergency.

And on the county’s end, Human Resources Director Curt Euler said he’s communicating with employees and trying to find alternatives. “Out of network is really bad for the employee. I don’t know what providers will charge if it’s a different amount … that’s what’s scary,” he said, adding that unless BCBS negotiates costs with Mission and other providers, there is no telling what prices might be.

Euler said the county’s contract with BCBS expires in September, and, “we have to decide if we stay with BCBS or go somewhere else.” As for alternatives, he listed: UnitedHealthCare, Park Ridge Health and Mission’s own service as potentials. He also said the county would need to notify BCBS by the end of August if it wants to terminate its contract, a move he noted would not prohibit further negotiations with BCBS.

According to county calculations, loss of BCBS coverage would have employees paying more. BCBS administers the county’s claims and negotiates rates with providers for services. He said that based on one of the plans offered by the county, the maximum out-of-pocket cost for an employee is currently $750 for a $5,000 service, with the county picking up the difference.

Euler said that if county employees became out of network, then they would be responsible for 100 percent of the bill and would have to file a claim with BCBS, and eventually be directly reimbursed. He said a $10,000 procedure would likely cost an employee $6,500, with county settling the difference.

COST COMPARISON: The two above charts from Buncombe County Human Resources Director Curt Euler show comparisons between how much county employees would pay for and how those services are reimbursed, based on being in versus out of network. Charts courtesy of Buncombe County.

To that end, Euler said the county is working with employees who have procedures scheduled past the Oct. 5 deadline. Mission and BCBS also noted they have resources available to provide information and options about health care continuity and upcoming appointments.

Meanwhile, County Manager Mandy Stone said that health benefits are intentionally robust, as they are a primary tool for recruitment and retention. “We compete for a workforce with specialized credentials. It’s your social workers, law enforcement officers … things that will stop the county from functioning as a healthy, stable community. That weighs heavy on us.”

As for future talks between Mission and BCBS, “Odds are we want it to happen. It should be good if BCBS has the same perception we have,” said Hoggard-Green.

“It is our hope that the termination be rescinded and BCBS will be back to the table negotiating a deal on behalf of our customers,” said Brady.