WELCOME
Member Town Hall
Negotiation Update
Blue Cross and Blue Shield of Nebraska is an Independent
Licensee of the Blue Cross and Blue Shield Association.
Agenda
• Background and Overview
• Which Doctors/Hospitals are Impacted?
• What if an Agreement is not Reached?
• How do I Continue My Care?
• Where do I Get More Information?
• Questions and Answers
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Background Information
• We have had positive, productive relationships with
CHI facilities and UniNet providers across Nebraska
for decades
• This negotiation has nothing to do with the quality of
care provided to our members
• It is about the cost of health care services in Omaha
– Blue Cross and Blue Shield of Nebraska has a
responsibility to our members to control
health care costs
• Note: This does NOT impact Medicare
Supplement members (except for some FEP members)
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Why We’re Here…
• We believe consumers have been kept in
the dark too long about health care costs.
• Better decisions can be made by
consumers and physicians when they
have information about cost and quality.
• Alegent Creighton/CHI contends these
negotiations should happen “behind
closed doors.”
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This Issue is Simple…
UniNet / Alegent Creighton Health costs are
significantly higher—in Omaha—than
other providers:
• 10% higher Physician costs
• 20% higher Inpatient Hospital costs
• 30% higher Outpatient Hospital costs
This adds millions of dollars in excess cost
for our employer groups and members in
Nebraska.
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• The cost of services is
significantly higher at
Omaha CHI facilities
and with UniNetcontracted physicians
• This significantly
drives up the total cost
to treat patients
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Who is Impacted by a Termination?
Outside of Omaha, most physicians are not
affected, but hospitals are
Alegent Creighton Health -- Omaha, Schuyler, Plainview
Good Samaritan Hospital -- Kearney
Nebraska Heart Hospital -- Lincoln
Saint Elizabeth’s Medical Center -- Lincoln
Saint Francis Medical Center -- Grand Island
St. Mary’s Community Hospital -- Nebraska City
1,400 + Omaha-area providers
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Why are Facilities outside Omaha Impacted?
• When Denver-based CHI became involved, they
moved their hospitals in Nebraska under the
Omaha UniNet contract.
– Previously all contracts were separate
• The current contract was completed in 2009
– It had annual renewals with automatic cost
increases
– This led to Omaha facilities and physicians
becoming much more expensive than others
– Rather than work with us to address the cost
issue, UniNet relied on the contract for further
increases.
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Attempts Have Failed to Focus on Omaha
• We have a general agreement on
reimbursement for facilities outside the Omaha
area
– We have proposed several times to remove these
facilities from this potential termination
– UniNet/CHI insists on negotiating as one large
organization
• Our intent is to limit disruption for members in
communities where we have a general
agreement
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Negotiation Overview
• April 23
Termination Notice sent to CHI
• May – Aug.
Weekly meetings with CHI
• Aug. 31
Contract terminates
BCBSNE has been committed to reaching an
agreement that is fair and controls costs for our
members…CHI has been slow to respond, and
has not addressed the cost issue.
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Negotiation Timeline
“There have been no delays on the Uninet side, in
fact it’s becoming increasingly clear that Blue
Cross Blue Shield is intending to push these
negotiations to the wire, or even maybe they’re
intending to push UniNet out of network.”
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Setting the Record Straight
“They (BCBS) are unwilling to leave an old, out of
date business model, a fee-for-service model, and
move into a value based world.”
• We have partnered with CHI on several
programs to reward them for improving health
outcomes for our members.
• In this negotiation, we were first to offer a
comprehensive value-based proposal.
• We don’t believe our members should pay
additional bonuses on top of CHI’s high costs
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CHI’s Proposals to Date…
• Have not offered any reduction in the costs at
Omaha hospitals
• Have only offered a small reduction to Omaha
physician costs – keeping them significantly
above other Omaha health care professionals
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If An Agreement Is Not Reached
• CHI facilities and UniNet Omaha providers will
be out-of-network as of September 1, 2014
• BCBSNE members can then choose to:
– Use a non-CHI provider or facility
OR
– Continue using a CHI facility/provider, which will
result in a higher cost to you.
– The facility or provider may also choose to bill
you for the difference between what BCBSNE
pays and the full amount the provider bills for a
service.
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Finding a Non-CHI Provider
www.nebraskablue.com/update
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Finding a Non-CHI Provider
Customer Service Representatives are here to help tonight, if needed
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Continuing your Care
Certain conditions allow you to continue care in-network
• Currently undergoing:
– Non-surgical or surgical treatment for cancer
– Active treatment for severe or end-stage renal disease or dialysis
– Active treatment for HIV and AIDS
• Pregnancy after first trimester or high-risk pregnancy
• Recent bone marrow or organ transplant; on waiting list to obtain an
organ
• Currently receiving:
– Inpatient services at a facility on the day of termination of contract
– Outpatient or inpatient treatment for mental illness and/or
substance abuse by a licensed mental health provider
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Continuity of Care Process
Please submit application
by August 31, 2014
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Emergency Care
• Emergency care (ambulance and emergency
room) is treated at in-network benefit levels in
most cases (in-network deductible, coinsurance,
etc.).
• Members may be billed by the provider for the
difference between what BCBSNE pays for the
services and the full charge from the provider.
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Impact to Federal Employee Program (FEP)
• Standard Option members will pay out-ofnetwork rates if they use a CHI provider after
August 31, 2014
• Basic Option members have no out-of-network
benefits unless services rendered are related to
the treatment of a medical emergency or
accidental illness
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Impact to Federal Employee Program (FEP)
If you are an annuitant and Medicare is your
primary coverage:
• Your Service Benefit Plan still covers Medicare
copays and coinsurance if you have Standard
Option
• There are no benefits available for Basic Option
members
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Important Things to Know
• CHI facilities and UniNet providers are in-network
through August 31, 2014—nothing changes
• We recommend Continuity of Care applications
be submitted by August 31, 2014
• Medicare Supplement members are NOT
affected (except for some FEP members)
• Retail pharmacies and prescription drug
coverage are NOT impacted—even if they are
prescribed by a CHI physician
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Bottom Line: Taking Care of Our Members
• You shouldn’t have to pay more for the
same health care services you can get
elsewhere at better prices.
• As Nebraskans serving Nebraskans, we
take our responsibility seriously to be a
catalyst for affordable, high quality health
care across our state.
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We’re Here to Help
(844) 286-0855
NebraskaBlue.com/Update
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QUESTIONS?
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