Brittney Lofthouse – Staff Writer

When news broke earlier this year that Blue Cross Blue Shield of North Carolina and Mission Health Systems couldn’t reach an agreement to continue their contract, county leaders immediately got to work on what to do in the event that the agreement will expire on October 5, resulting in those insured by BCBS becoming “out of network” for doctors within the Mission Health System.

For Macon County, that would mean about 360 county employees currently insured by BCBS looking for alternative options for care if they had previously used doctors within Mission’s umbrella. County Manager Derek Roland informed county employees on Sept. 22 that with Mission and BCBS still unable to reach an agreement,  Mission Health System will no longer be in-network for county employees on Oct. 5.

“As each of you are aware, Blue Cross Blue Shield is the insurance provider for Macon County,” Roland wrote to county employees last week. “Although Mission Health System will be out-of-network after Oct. 5, 2017, Macon County will continue to use Blue Cross Blue Shield as our insurance provider moving forward.”

Roland said the decision was difficult, but remains confident that it was the best decision for Macon County and its employees due to the extreme cost of leaving BCBS and seeking a new insurance provider.

“From a financial standpoint, switching to a new insurance provider was cost prohibitive,” said Roland.  “At a minimum, it would have cost the county and employees  an additional $600,000-$750,000 in this fiscal year alone to switch providers. The vast majority of this increase would have been borne by those employees with dependents. This is a cost that the county nor the county employees can absorb in this fiscal year.”

Roland noted that for employees who are specifically using Mission and/or Mission health services, the county’s decision will cause some disruption as they will begin incurring out of network charges if they continue to use those health services after Oct. 5 ,2017.

“In an effort to minimize this disruption we provided employees with resources to help them find new providers that remain in the BCBS network and lie within a 50-mile radius,” said Roland. “We continue to have very productive discussions with representatives from Harris Regional Hospital as well as representatives from Northeast Georgia Hospitals who will remain in our network after Oct. 5, 2017.  In addition we will continue to provide our employees with the fully operational employee health clinic.”

Employees who are served by private practices or doctors outside of Mission’s network, will not be impacted on Oct. 5.

Roland also announced that Macon County will be launching the MDLIVE telehealth services after Oct. 5, 2017 to help all employees receive easier access to health care.

“Essentially this is a convenient way for all employees to have access to a board certified doctor through a secure online video at no cost to them,” said Roland. “This service can be accessed at home on your computer or on the go through use of the MDLIVE mobile app.”

Roland said that the county hopes that negotiations will continue between Mission and BCBS.

“We remain hopeful that the ongoing network issues between BCBSNC and Mission Health will be resolved in the near future,” said Roland. “In the meantime, we will continue doing everything we can to ensure that Macon County employees have access to top quality health care and health care alternatives.  Again, while this was a difficult decision, it was the best decision for both Macon County and the Macon County employees.”

Mission Health remains steadfast in their belief that if BCBS would negotiate with them, a resolution can be reached before Oct. 5.

“On Oct. 5, Western North Carolina will awaken to a completely different healthcare world,” John Ball and John Garret, Mission Health’s Board Chair and Vice-chair said in an a release over the weekend. “At a time when sick or injured and they can least afford it, hundreds of thousands of BCBSNC members will face impossible to understand rules, potentially higher out-of-pocket costs and relentless pressure from BCBSNC to move their care away from trusted Mission Health physicians and hospitals.

“Mission Health will do everything we possibly can to alleviate the resulting harm, anxiety and frustration. But none of this needs to happen. There are three clear ways that to permanently solve this problem before Oct. 5:

“1. BCBSNC could accept the fair and reasonable offer that Mission Health made back in June.

“2. Mission Health could accept BCBSNC’s demands for a “one year, zero rate increase pause” as part of a long-term contract that also ensures Mission’s long-run stability (if BCBSNC does the same).

“3. Most practically, BCBSNC and Mission Health could simply start fresh and negotiate an agreement that ensures high quality, affordable and effective care for the one million people who count on both of us.

“These three paths to resolution could solve this problem before Oct. 5 — but only if BCBSNC will join us in a discussion about our differences. Despite this being something that we routinely teach our children, having a conversation is something that BCBSNC has repeatedly and categorically refused to do, even despite the consequences to so many.”

Both Ball and Garrett noted in their released statement, that despite the deadline, the conversation or attempt at a resolution should never end.

“Without knowing their hearts and minds, we presume that BCBSNC board members also believe they are doing the right thing,” said the release. “That is their fiduciary responsibility, even if we don’t agree with the very unfortunate way BCBSNC has advocated for its position. Good people can disagree and struggle to reconcile their differences. Yet, in a situation with consequences impacting one million people, none of us should ever, ever give up.”