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OMAHA, Neb. (AP) — A major Nebraska health insurer has been unable to come to terms with one of the state's biggest medical networks, so thousands of people are either facing significantly higher costs or changing doctors.
No talks have been held since the contract between Blue Cross Blue Shield of Nebraska and Catholic Health Initiatives expired Sept. 1. So the facilities and doctors affiliated with Catholic Health Initiatives are no longer part of the Blue Cross network.
"Blue Cross has created a mess for people all across the state of Nebraska," said Dr. Cliff Robertson, CEO of CHI Health.
The expired contract covered all CHI Health hospitals in Omaha, Schuyler and Plainview. It also includes hospitals in Lincoln, Grand Island, Kearney and Nebraska City affiliated with Catholic Health Initiatives.
A network of doctors in the Omaha area is also affected by the contract. Blue Cross said about 530 of those roughly 1,400 doctors have changed their affiliation, so they could remain in network.
The two sides negotiated all summer, but remain far apart on costs. Robertson said CHI Health is prepared to remain out of network for an extended period.
Blue Cross said CHI Health, which used to be Alegent Creighton Health, routinely charges 10 to 30 percent more than other Omaha hospitals. CHI Health says those figures are misleading and its total cost of treatment is lower even if certain services cost more.
"We do want them to be in the network," said Lee Handke, a senior vice president with Blue Cross.
To that end, Blue Cross is drafting a proposed contract that it will submit to CHI Health with the next week or so, but that proposal will be less generous than what the insurer offered during summer talks.
Robertson said he thinks the key disagreement has been over the payment model. CHI Health wants to continue moving away from a traditional system that promises payment for certain services to one that focuses more on the overall well-being of patients and the total cost of treatment.
The next couple of months may play a key role in the negotiations because Nebraska companies and individuals will be deciding whether to sign up with Blue Cross for 2015 or choose a competitor whose insurance network includes CHI Health doctors.
Blue Cross said about 110,000 of its policyholders were treated at a CHI Health facility or by a doctor affiliated with that network in the past 18 months.
Both sides say many people are confused about how the dispute affects them. Blue Cross is holding online town hall meetings this week, and CHI Health has fielded more than 2,600 calls to a hotline it set up in late August.
Blue Cross Blue Shield update: http://update.nebraskablue.com
CHI Health site on negotiations: http://www.chihealth.com/bcbs
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