With just over a week left to strike a deal, Minnesota's largest children's hospital and a dominant insurer in the state appear to be moving further apart as they attempt to negotiate a network contract that will determine payment rates for health care provided to thousands of very sick children.
Children's Minnesota, which has two hospitals and two dozen clinics in the metro area, is in the midst of tense contract negotiations with Blue Cross and Blue Shield of Minnesota, whose commercial and Medicaid health plans cover about 66,000 patients of the pediatric provider.
Without a deal by July 5, Blue Cross patients who go to Children's Minnesota will start getting billed for out-of-network care, which will be much costlier than the in-network bills they're used to paying.
The higher rates will force many of the patients to switch doctors or hospitals. Children's Minnesota says it has identified more than 6,000 children whose needs are especially acute and who the hospital believes could not get the same level of care elsewhere.
Although Blue Cross says it's working to make sure those patients get an in-network doctor, Children's Minnesota pediatrics chief Dr. Gigi Chawla said at a news conference Monday that it was "simply implausible" that other hospital systems could provide the same level of care.
Blue Cross, meanwhile, said that Children's Minnesota provided it with a list of about 3,700 eligible Blue Cross members with complex medical cases whose care should remain in-network; the insurer has agreed to approve continued treatment for each eligible Blue Cross member on that list.
Glenn Pomerantz, chief medical officer for Blue Cross, wrote in a blog post Monday that despite a long-standing productive relationship with Children's Minnesota, "this relationship has been under significant pressure" this year because of disagreements over the payment rates.
Pomerantz listed five other children's hospitals, including one based in North Dakota, that are enrolling new Blue Cross patients.