Contract disputes and payer splits are threatening coverage nationwide, and some ASCs are being affected by the parties unable to meet year-end or looming deadlines.
Here are four disputes or splits affecting ASCs and clinics:
1. Although Regence BlueShield of Washington came to an agreement to keep commercial members in network at the Polyclinic in Seattle and the Everett Clinic, the payer's Medicare advantage members are still in limbo.
Regence BlueShield of Washington's contract with Optum-owned Everett Clinic and Polyclinic expired Dec. 5, and the two sides on Dec. 22 reached an agreement to keep commercial members in network. But negotiations between the clinics and Regence BlueShield are ongoing, The Daily Herald reported Jan. 10, and multiple Regence BlueShield Medicare Advantage members told the newspaper they had been denied care at the Everett Clinic because their plans are now out of network.
2. Blue Cross Blue Shield of Tennessee ended its relationship with Memphis-based Methodist Le Bonheur Healthcare, and two ASCs are affected. In total, 11 locations have been removed from the networks, including Methodist Le Bonheur Germantown Surgery Center. Another ASC, Wolf River Surgery Center, will be out of network effective Oct. 23.
3. Anthem Blue Cross could go out of network with Fredericksburg, Va.-based Mary Washington Healthcare if the two sides cannot agree on a new contract by March 1. According to a statement on Mary Washington's website, the health system's ASC and endoscopy center would be affected.
4. A contract between Blue Cross Blue Shield of Texas and Austin-based Ascension Texas is set to expire Jan. 31, which would force 10 Texas hospitals, 10 ASCs, two medical centers and 32 hospital-based clinics out of network. Most of the potentially affected centers are located in the Central Texas and Hill Country regions.
Negotiations between Blue Cross and Ascension have been going on for months, according to a Jan. 4 report from MySanAntonio.