Insurance talks may impact university employees

As the deadline in negotiations between Blue Cross Blue Shield and Catholic Health Initiatives approaches, UNMC workers may have questions about their coverage. Some frequently asked questions are answered below.

For a video of the employee forum, click here.

Do I need to find a new health care provider?
Currently, your coverage remains the same, and you will continue in‐network benefits when visiting a CHI facility or affiliated physician. If an agreement is not reached by Aug. 31, CHI-affiliated hospitals and physicians located in Nebraska, or billing directly through Nebraska, will no longer be part of the Blue Cross and Blue Shield of Nebraska provider network. Members may choose to select another in-network hospital or physician, or to use CHI services and receive benefits at the out-of-network level.

To ensure the proper level of care is continued, please begin working with your health care provider to explore your alternatives and find an option that meets your medical needs. Some helpful suggestions are described below.

Outside of the Omaha area, a termination of the CHI contract would primarily impact hospitals and not physicians. Most physicians outside of the Omaha area are under a different agreement and are not impacted by this negotiation. To determine if your physician or local facility is impacted by the negotiation, search the list found here under the “My Doctor” section.

If you plan to seek care after Aug. 31 and want to be sure your provider is in‐network regardless of the result of the negotiation, you may also want to explore the list of non-CHI providers available at this website.

To read the letter from Blue Cross/Blue Shield, click here.

What if I have specific questions about my hospital, provider, benefits or medical situation?
Please call BCBSNE’s member hotline at (844) 286-0855 with any questions or
concerns. Hours for the hotline are: 7:30 a.m. to 6 p.m. Monday through
Friday.

Additional information is available and frequently updated here, and you can also submit questions directly to BCBSNE via the “Contact Us” link on the home page of that site.

Are retirees affected?
If an individual has a Medicare Supplement policy, they are not affected. Those who have the University of Nebraska retiree medical insurance who are not age 65, as well as those age 65 without a Medicare Supplement plan, will be impacted. The university’s retiree medical insurance is not a Medicare Supplement Plan, it is a secondary coverage. For those on the university’s plan who are age 65, ask if your physician accepts Medicare assignment (i.e., will they accept what Medicare pays as payment in full). The other exception would be retirees on certain Federal retirement plans.

What happens if I am taken to a CHI Emergency Room due to a true emergency?
For the first 48 hours, a patient will be billed under the in-network rates under insurance. However, any balance over the contractual rate may be billed directly to the patient. Also, after the first 48 hours, patients will be billed at non-preferred provider rates. Patients may request a transfer to a preferred provider hospital after they are stabilized.

Are prescriptions affected by this?
No. The University of Nebraska has their prescription coverage through CVS Caremark, not through Blue Cross Blue Shield.

If I contact Blue Cross, is there anything I should take note of during the call?
Document the representative’s name, as well as the date and time. All phone conversations are recorded and can be reviewed if needed.

What do I need to do to determine if my provider is still considered in-network?
An updated list of covered providers can be found here. Some providers are setting up direct contracts with Blue Cross to keep their patients in-network. Most of these providers are waiting to see the result of the negotiations between Blue Cross and CHI before signing an individual contract with Blue Cross.

Individuals may want to contact their provider and ask whether they will still be considered in-network after Aug. 31. Do not ask if they will still accept Blue Cross Blue Shield, as most providers will accept the insurance but bill individuals at the out-of-network rates.

If I’m about to have a baby, or if I have cancer or another serious
condition, will I be able to keep my doctor if an agreement is not reached?
Should an agreement not be reached, certain conditions will qualify for continued care and in-network benefits with your existing CHI provider, for an extended period of time. Employees who may qualify must complete the “Continuity of Care” application with their physician, and return it by Aug. 31. To determine specific details for your condition or situation, please visit the Continuing My Care page here.

Do I need to complete the “Continuity of Care” application if I am already seeing a non‐CHI provider that is not impacted by the possible termination?
No. “Continuity of Care” applications only need to be submitted if you are currently under treatment for an approved condition with a CHI-affiliated provider that would no longer be considered in-network should an agreement not be reached and the termination go into effect on Sept. 1.

What is the timeline from submission to determination of approval/denial for the “Continuity of Care” application?
The process takes approximately five to six business days. You will receive a written response mailed to your home address concerning your request.

My doctor and hospital are affiliated with Catholic Health Initiatives (CHI). If they no longer contract with BCBSNE, how would that impact me financially?
You would be responsible for a larger share of the costs. CHI providers would be considered non-contracting effective Sept. 1, and claims for all services
received from CHI‐affiliated providers will be processed as out of network.

IMPORTANT: Not only would benefits for covered services be subject to higher deductible and coinsurance amounts if you go to a non-contracting provider, you could also be billed for amounts over BCBSNE’s benefit allowance. This could result in a significant financial liability for you. Here’s an example:

You are hospitalized in a non-contracting facility. The hospital’s billed charges total $15,000. BCBSNE’s benefit allowance for these charges is $8,000. Because the hospital is non-contracting, they can bill you for the difference between the billed charges and BCBSNE’s benefit allowance. That’s $7,000 you will have to pay that you wouldn’t have to pay if you go to a contracting BCBSNE hospital.

Out of the $8,000 that BCBSNE considers eligible charges, you are responsible for the out-of-network deductible amount ($650) and coinsurance (45% up to a calendar year maximum of $2,000.)

So out of $15,000 in billed charges, your liability at a noncontracting hospital is:

$650: out-of-network deductible
$2,000: out-of-network coinsurance maximum
$7,000: difference between billed charges and BCBSNE benefit allowance

Your total liability: $9,650

This does not include any charges for non-covered services, which also are your responsibility.

If you had used a contracting hospital, your liability for the same $15,000 bill would have been the following:

$450: in-network deductible
S1,600: in-network coinsurance maximum

Your total liability: $2,050

On the in-network coinsurance maximum, you can’t be billed for the $7,000 difference between billed charges and BCBSNE benefit allowance.

The total liability here does not include any charges for non-covered services, which are your responsibility.

If you use noncontracting providers, BCBSNE would send the benefit payment to you, and you would then be responsible for reimbursing the provider. You may also be required to file your own claims. When you use contracting providers, they file claims for you and BCBS pays them directly.

Is my dental insurance impacted?
General dental work is not affected by this negotiation; however it may have an impact on some oral surgeons.

If Blue Cross and CHI are still negotiating after Aug. 31, are CHI providers still in-network?
No. Even if negotiations continue after Aug. 31, the CHI providers will still be considered out of network.

Does this affect me if I go to a provider in Iowa?
This will potentially impact some providers in Iowa. The way your provider bills insurance will be the deciding factor. If they bill through Iowa, then you will not be subject to the out of network costs. If they bill directly to Nebraska, then you will see the out of network costs.