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Network Disruption Update: BlueCross BlueShield Network S and HCA/TriStar Facilities

By Heather Eshaghpour  

It is our commitment to keep you up-to-date on any news that could affect your employees’ coverage, including significant provider network disruptions. In keeping with that commitment, we wanted to let you know that there is a fee agreement change that can significantly affect BlueCross BlueShield of Tennessee (BCBST) Blue Network S members.

History

To put some context around this issue, prior to 2015, there was a contentious scenario between BCBST and the TriStar Health System for claims incurred for the period of January 1, 2007 – December 31, 2014 related to emergency room services. During this period, we had members experience balance billing charges in excess of $25,000. Fortunately, TriStar and BCBST resolved those differences and allowed anyone affected by this to have their balance billing issue resolved and allowed for continued access by Blue Network S members for life or limb threatening issues to be treated at a TriStar facility without the risk of future balance billing.

Negotiations Have Broken Down

BCBST and TriStar will be notifying you this week that the special agreement to resolve these issues ends on December 31, 2017. While it is not uncommon for health plans and health systems to negotiate these issues, at this point the negotiations between the two parties have broken down.     

Starting January 1, 2018, the balance billing charges that Blue Network S members could experience can be significant. BCBST is notifying members who recently have used a TriStar emergency room, but all Blue Network S members need to be aware of this change.

Avoid Tristar Hospital Facilities

Members can continue to go to any provider they choose, but to avoid significant charges in case of an emergency, they need to go to a non-TriStar hospital emergency room when possible. In some cases members may not have a choice if they are taken by ambulance. These situations may also result in balance billing. 

We Will Keep You Updated

We are still awaiting some answers from BCBST around what changes will be allowed for groups that are currently outside their annual renewal/open enrollment period.   Contact us to determine the best strategy for your specific group.

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