WVU Hospitals’ Blue Cross/Blue Shield Contract Expires

Hospital expects to be “out-of-network” on May 1

MORGANTOWN, W.Va. – West Virginia University Hospitals’ three-year contract with Blue Cross/Blue Shield expires May 1, and hospital officials expect to be classified as an out-of-network facility for Blue Cross policyholders as of that date.

“We will continue to provide the same high level of care to Blue Cross patients as we always have – but there will be changes in how your hospital bill is processed,” said WVU Hospitals President and CEO Bruce McClymonds.

WVUH has requested renewal negotiations with BC/BS for many months, he added. In recent weeks, it has become clear that the insurance company is unwilling to adjust its payment rates to WVUH to align more equitably with what other insurers pay WVUH, or with Blue Cross payment rates with the two West Virginia hospitals that provide similar services, Charleston Area Medical Center and Cabell-Huntington Hospital.

For patients, the switch to an out-of-network status will mean that health care services at the area’s only tertiary referral hospital, trauma center and regional cancer center will be more costly.

Hospitals that are in an insurance company’s network usually have a discount contract with insurers that protects patients from having to pay any amount above the deductible and co-pay required by their plan. The expiring WVUH-Blue Cross contract is such a discount contract. 

When a patient uses an out-of-network hospital, the insurance company will determine how much of each patient’s bill they will cover. Most likely, they will send a check for this amount directly to the patient, leaving the patient responsible for the balance of the bill.

“WVU Hospitals is eager to complete negotiations and sign a contract with Blue Cross,” McClymonds said. “Until that happens, we’ll continue to care for the thousands of Blue Cross customers who depend on us.”

WVUH and Blue Cross have made special arrangements for patients in the hospital on May 1, those who are preparing for childbirth at WVU Children’s Hospital and those who are already scheduled for surgery or other care during the month of May.

This change does not affect coverage for WVU physician visits at the Physician Office Center, Sleeth Family Medicine Center or other University Health Associates locations or at WVU Cheat Lake Physicians. It will affect costs for x-rays and other services performed at hospital facilities.

William MacLean, who has led the team negotiating with Blue Cross, says it has been a frustrating process. “During the three-year contract term our average Blue Cross discount more than doubled,” he said. “Our inpatient discount almost tripled. No other private insurer is demanding these sorts of steep discounts, and we consider an adjustment long overdue and fully justified.”

“We asked that the renewal discussions begin early, and told Blue Cross some time ago the results under the expiring contract would not allow us to extend it beyond its termination date,” he said. “We’ve also proposed a one-month extension with only a token increase in rates, to allow negotiations to continue, but they have been very unresponsive.”

Patients with questions about a bill should call the telephone number listed on the bill. For general questions about future hospital bills, call WVU Hospitals Patient Financial Services at (304) 598-4032. For questions about your insurance plan, please call your employer’s benefits office.

- WVU -

For more information:
Bill Case, HSC News Service, (304) 293-7087

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