BCBST Rejects all CHI Memorial Proposals to Remain in Network

For many months, CHI Memorial has been negotiating in good faith with BlueCross BlueShield of Tennessee (BCBST) to retain CHI Memorial’s high-value hospitals and physicians in their networks. Unfortunately, BCBST has rejected all our proposals.

Without resolution, BCBST patients may lose access to CHI Memorial on July 1.

Then BCBST patients will be forced to select another physician who does not know their medical history and potentially travel greater distances for high-quality care. 

It is very disappointing. BCBST has $4.1 billion in cash reserves that could be used to pay providers fairly without raising premiums. Other insurance companies have agreed to help CHI Memorial with inflation, and BCBST should as well. 

Our numerous proposals reinforce with BCBST that CHI Memorial’s value lies in our integrated, high-quality, cost-efficient care, provided by the largest physician network with the most convenient access points. CHI Memorial hospitals, CHI Memorial Medical Group, and The Chattanooga Heart Institute act as one integrated health system standing united to serve our patients. The integration of our hospitals and physicians is how we keep patients healthy and costs down.

Now, we need your support.
 

YOUR VOICE MATTERS
Ask BCBST Leadership to reach a new agreement with CHI Memorial to keep access to the hospitals, physicians, and nursing teams you know and trust. 

CALL OR WRITE BCBST leadership immediately:

Commercial networks (S and P) 1-800-924-7141
Medicare Advantage 1-800-924-7141
Medicaid (BlueCare) 1-800-468-9736
Email: [email protected]

EXPLAIN WHY CHI MEMORIAL MATTERS to you:

  • Recognized as a high-value health system by national organizations.
  • Offers the largest network of physicians, specialists and advanced practice providers with convenient access.
  • Invests in unique clinical innovations and the latest treatments, ensuring local access to high-caliber care.
  • Only faith-based health system serving the region for over 70 years, providing $100m+ in community benefits and uncompensated care last year.
  • Removal from BlueCare jeopardizes long-standing provider relationships, compromises care, and escalates health care costs.

In the meantime, our contract remains in place through June 30, 2024. Continue to keep all scheduled appointments and procedures at CHI Memorial and do not delay routine health screenings, procedures, and tests that are important to your health.

INSURANCE PLANS ACCEPTED

You can view a list of all health plans accepted by CHI Memorial and learn more here. We are committed to supporting patients to remain with the physicians and hospitals they know and trust. 

More About our Conversations with BlueCross

We’re requesting reasonable increases. BlueCross BlueShield of Tennessee (BCBST) reimbursement has not kept up with inflation, so we are only asking BCBST to pay its fair share of rising health care costs as other insurance companies have already done.

Without a reasonable increase, CHI Memorial could be forced to reduce or eliminate services, like 57% of hospitals have been forced to do.

 

During the pandemic, BCBST earned record profits and increased cash reserves to $4.1 billion. These funds can be used to pay CHI Memorial a fair increase without raising premiums or shifting more costs to employers and patients.

It’s time for BCBST to help the 50% of Tennessee hospitals - like CHI Memorial - who are struggling as a result of the pandemic. Our costs alone have increased 30% since the start of the pandemic, while BCBST enjoyed record profits.

Unfortunately, no. BCBST's public statements promising that their members can keep their physicians even if CHI Memorial goes out of network have complicated negotiations and pose risks to patient care by attempting to fragment our continuum of care. Their statements are misleading and confusing.

Imagine having a primary care doctor in your insurance network, but all referred services (e.g., tests, surgeries) are out-of-network. You'd face out-of-network charges to receive those services at CHI Memorial where your physician knows you will get the best care. 

CHI Memorial hospitals, CHI Memorial Medical Group and The Chattanooga Heart Institute are one integrated health system standing united to serve our patients.

Certain insurance companies are increasingly imposing unnecessary barriers to care that have a human cost:

  • improper use of utilization management programs, 
  • inappropriate denial of medically necessary covered services, 
  • overly restrictive medical necessity criteria that are not transparent to patients or providers, 
  • unnecessary and unreasonable documentation requirements,
  • mid-contract changes to patients’ coverage
  • Government agencies, courts and arbitrators, are concerned that these practices are being used by some insurers as “a strategy…to avoid legitimate payment obligations.”

They also drive up administrative costs, contribute to clinician burnout, and strain the healthcare system. These practices not only harm enrollees but also jeopardize providers' financial stability, with hospitals reporting over $6 billion in delayed or potentially unpaid claims.

Last year alone, BCBST denied more than $3 million in payment to CHI Memorial for services provided to patients for necessary medical care.

Yes, unfortunately BCBST did not agree to a new contract that would support our ability to provide quality patient care to their Health at Home patients. So since March 29, 2024, CHI Memorial Health at Home has been out of network with these BlueCrossBlueShield plans:

  • Blue Advantage (Medicare Advantage Product)
  • BlueCare Plus (Dual Medicare and Medicaid Product)
  • All BCBST Commercial Plans (including networks s and p)

CHI Memorial Home Health remains in network for Blue Care (Medicaid only TN Care product) through Jan. 1, 2025.

These services are included in our negotiations, but will remain out of network until BCBST accepts a reasonable proposal from CHI Memorial.

Working Together to Put Patients First

CHI Memorial will continue to work in good faith with BCBST to remain in their network for all products, including Medicare Advantage and all commercial plans. We hope BCBST will reverse their decision and agree to a fair agreement before our contract expires on June 30, and to achieve our goal of preserving patient access. CHI Memorial remains committed to putting patient needs first and allowing residents in Tennessee and Georgia to continue accessing the care they know and trust.