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Doctors speak out on healthcare negotiation impacting relationships with lifelong patients

Not only are patients being impacted by the Blue Cross Blue Shield and Methodist Le Bonheur negotiations, but doctors are as well.

MEMPHIS, Tenn. — Contract negotiations between Blue Cross Blue Shield of Tennessee and Methodist Le Bonheur Healthcare are ongoing with no clear end in sight as employers begin to make negotiations with BCBST to remain temporarily in network.

In a statement to ABC24, Methodist Le Bonheur Healthcare said:

Negotiations are ongoing with BCBST to reach a resolution that benefits all patients. However, we understand that some employers such as the City of Memphis and St. Jude have made special arrangements with BCBST to remain in network for at least 30 days pending the outcome of negotiations. We encourage other employers and their respective employees to reach out to BCBST to request the same special exemption.

Doctors Paul Carruth, a diagnostic radiologist, and Jordan Coffey, an anesthesiologist, are facing the brutal end of contract negotiations as lifelong patients are turned away for everyday services.

“Starting January 1, when Methodist Le Bonheur Healthcare went out-of-network, those patients who had been seeing us for their inpatient hospital care and also diagnostic outpatient services, no longer could come see us,” Dr. Carruth said. “So we just sort of lost this percentage of the people that we had a relationship with.”

Not only are patients having to find new locations for imaging services, but transplant patients are also getting displaced.

“Yes, we have already seen surgeries cancelled,” Coffey said. “25 percent of our liver transplants [in 2022] were Blue Cross patients. It’s frustrating those patients now can’t have routine lab-work drawn at Methodist facilities. I suppose they’re being told either go to Nashville to Vanderbilt or to UAB in Birmingham.”

However, some patients are being cared for without an excess bill using the No Surprises Act. Taking effect in Tennessee on January 1, 2022, the No Surprises Act prevents a provider from charging a patient the difference between what they charge and what the insurance company pays, but someone still has to foot the bill.

“We still bill Blue Cross but there’s no set rate,” Dr. Carruth said. “They will basically pay us what they feel like they want to pay us, which so basically going to be a Medicare rate. So, we kind of just don’t get paid."

Methodist encourages patients still wanting to seek healthcare through their system to reach out to the version of Blue Cross Blue Shield they pay for to request a special exemption, but many patients haven’t done that and are having to be turned away.

“Our front desk people were having to field calls from Blue Cross patients and tell them ‘I know you’ve seen us for years and years, but at this point we can’t provide your services and that’s a real issue for women who have to deal with the stress every year of that screening mammogram,” Dr. Carruth said.

Once a patient does find a new doctor, the wait could be long. This, in part, due to the influx of patients the in-network hospitals are having to schedule.

“I know having listened to some of the obstetricians in town, they’re already overwhelmed at Baptist Women’s Hospital trying to get deliveries and procedures scheduled,” Dr. Coffey said.

Both Dr. Carruth and Dr. Coffey have met with legislators in the past and plan to meet with more in the future to discuss new legislation to better protect both patients and doctors from any issues that come out of the insurance negotiations.

Blue Cross Blue Shield of Tennessee provided ABC24 with the following statement:

We are keeping our site, bcbstnetworkupdates.com, updated and any developments in negotiations will be released there first so we recommend checking that site regularly. We continue to work toward agreement with Methodist and as we’ve stated before, we hope to bring them back into our networks.”

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