The two entities had been in negotiations for over a month, but did not finalize a new contract by the Dec. 31 deadline. Blue Cross Blue Shield is offering some extensions but on a case-by-case basis.
One family who received an extension is Starla Padgett and her daughter Alexis.
Alexis has cerebral palsy and needs around-the-clock care. Since no agreement has been met with Blue Cross Blue Shield of Tennessee and Methodist Le Bonheur Healthcare, Padgett’s fight is not only for her daughter’s life, but for proper care.
"My daughter has thrived because of Le Bonheur," Padgett said. "My daughter wasn’t supposed to make it to one [years old], so stop! Please.”
Since birth, Alexis has been a patient at Methodist Le Bonheur Children’s Hospital.
“Alexis has a lot of complex needs — cerebral palsy, HIE brain damage, trach, G-Tube — you name it, we got it.” Padgett said.
The best local option for Alexis is Le Bonheur.
“These other hospitals, I’m going to tell you right now, do not have the equipment and specialists for complex care needs,” Padgett said.
While Methodist Le Bonheur and Blue Cross Blue Shield of Tennessee continue to negotiate patients’ coverage, Padgett and Alexis are caught in the middle.
“It is out of my hands, and I can’t control it,” Padgett said.
After filing a complaint and appeal with Blue Cross Blue Shield, Padgett was given a 90-day extension for care. She would also have to get pre-authorization from her doctor for any procedure for Alexis.
If negotiations are not reached, Padgett has two options.
“My option is we’ve got to move and uproot my family, or I’ve got to change to one of these other insurances and start all over again,” Padgett said. “I’m frustrated because my daughter is the one suffering.”
Her message to the companies is simple.
"Stop pointing fingers. Please, reach an agreement," Padgett said. "Don’t do this to us."
Padgett said she is not going to stop and neither will other families in similar situations.
"Alexis is why I keep going because I’m her voice," Padgett said. "I’m her mother. I’m going to do everything I can to fight for her.”
Blue Cross Blue Shield of Tennessee told ABC 24 that Methodist Le Bonheur Healthcare is out of network for other Blue Plans as well. These include Arkansas and Texas.
Those plans may have their own protocols for helping patients get care at other facilities. If you are wondering if your care is affected, Blue Cross Blue Shield Association advises contacting your provider.