TULSA, Okla. — Blue Cross and Blue Shield of Oklahoma (BCBSOK) and Saint Francis Health System’s network contracts expired on April 30, 2021.
BCBSOK is currently in a 90-day transition period to allow members time to make decisions about their future care, as Saint Francis will leave BCBSOK networks on July 29, 2021.
This means BCBSOK members will still have in-network access to Saint Francis locations, clinics and physicians until July 29, 2021.
BCBSOK is notifying approximately 59,000 subscriber households.
This impacts all Saint Francis hospitals, off-campus locations, Laureate and Warren Clinic doctors and health care professionals.
BCBSOK members who are Saint Francis patients currently undergoing treatment for a disability, acute condition, life-threatening illness or are in their second trimester of pregnancy, may be covered by Continuity of Care.
This means BCBSOK members who meet the criteria and qualify may still be able to use Saint Francis at the in-network rates, after July 29, 2021.
To check eligibility in Continuity of Care benefits, BCBSOK members are encouraged to call the customer service number on the back of their ID card.
The vast majority of BCBSOK members have PPO plans that provide coverage for out of network benefits, so members can choose to utilize them anywhere they want, including Saint Francis Health System.
In the case of a life-threatening illness or injury: members should go to the nearest emergency facility right away. Emergency services are covered at members’ in-network benefit level. Any additional charges will depend on their health plan and applicable law.
The Issue: BCBSOK and Saint Francis were unable to reach an agreement that would protect members from unexpected future costs.
Saint Francis has more than 100 locations, but only four acute care hospitals. It continues to expand, adding clinics and retail locations. Unfortunately, Saint Francis refuses to recognize the distinctions that exist between on- and off-campus services in setting appropriate reimbursement rates. This means BCBSOK members may pay much higher out of pocket expenses for services at off-campus locations operated by Saint Francis.
Physical Therapy Example: Saint Francis’ hospital rates for physical therapy are three times more expensive than professional clinic rates. When Saint Francis bills off-campus physical therapy services at on-campus hospital rates, BCBSOK members pay much more out of pocket and in addition, must meet their deductible and pay a percentage of the overall bill.
Oncology Example: Saint Francis recently acquired a cancer treatment center/ clinic. It is an off-campus facility, but services rendered at this location are billed at on-campus (hospital) rates, which caused our members’ out of pocket costs to go up significantly, overnight.
Official Media Statement from BCBSOK:
After months of negotiation in good faith with Saint Francis Health System, BCBSOK and Saint Francis were unable to reach an agreement that would protect Blue Cross and Blue Shield of Oklahoma members and customers from future cost increases as the hospital system continues to grow and expand.
Saint Francis has more than 100 locations, but only four acute care hospitals. It continues to expand, adding clinics and retail locations. Saint Francis wants BCBSOK to reimburse many of its clinic and retail locations the same as the acute care hospitals. This would mean our members pay much higher rates for services at off-campus locations operated by Saint Francis. We want to ensure our members receive the right service, at the right place for the right price. This is not the outcome we had hoped for, but our networks remain strong and we are committed to help our members who decide to transition to the thousands of other quality, in-network providers in the Tulsa metro and across the state.
As a member-owned health insurer, negotiating physician and hospital contracts is one of the ways BCBSOK protects our members and customers from unnecessary and inappropriate increases in health care costs. While we understand prices go up over time, we must be good stewards of our members’ health care dollars to keep out-of-pocket expenses and premiums as reasonable as possible.
Cox Media Group