May 5, 2021
Saint Francis to Leave BCBSOK Networks
Blue Cross and Blue Shield of Oklahoma (BCBSOK) and Saint Francis Health System (Saint Francis) contracts expired on April 30, 2021. We are in a 90-day transition period. Saint Francis will leave our networks on July 29, 2021. This includes Saint Francis hospitals and Warren Clinic doctors and health care professionals.
Why it matters: Saint Francis will no longer be in these provider networks after July 29, 2021:
- Blue PreferredSM
- Blue Advantage PPOSM
- BlueLincs HMO
- Blue Choice PPOSM
- Blue TraditionalSM
- NativeBlueSM
The Issue: BCBSOK and Saint Francis were unable to reach an agreement that would protect our 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. It means our members pay much higher rates for services at off-campus locations operated by Saint Francis.
- For example, 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 rates, our members pay much more out of pocket and also must meet their deductible and pay a percentage of the overall bill.
- Another example is oncology services. Saint Francis recently acquired a cancer treatment center. It is an off-campus facility, but is billed at on-campus rates, which caused our members’ costs to go up dramatically overnight.
We want to ensure our members receive the right service, at the right place for the right price.
As Saint Francis continues to expand, we want the ability to evaluate each new location on its own merit and compensate appropriately. This protects our members from having to pay more out-of-pocket for their health care.
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. This impacts the cost of health care for all Oklahomans.
Background: The Centers for Medicare & Medicaid Services (CMS) does not reimburse all off-campus facilities the same as facilities on the main hospital campus. It recognizes that services performed at clinics and other off-campus locations such as physical therapy, drug infusion and MRIs should not receive the same compensation as these services at the main hospital campus.
Impacted hospitals: This includes all Saint Francis hospitals and other service locations, Laureate Psychiatric Clinic and Hospital, and the Warren Clinic doctors and health care professionals in the Tulsa area, Glenpool, Muskogee, Stroud, Tahlequah, Vinita, Wagoner and Warner.
Why negotiate: As a member-owned health insurance industry leader in Oklahoma, we work with doctors and hospitals to find solutions that are in the best interest of our members. We advocate on our members’ behalf for high-quality, cost-effective health care. It is a responsibility we take very seriously.
Finding in-network care: We will do everything we can to help members transition their care to other quality, cost effective, convenient in-network hospitals and doctors, if they choose.
Members have several ways to find in-network care:
- Visit our online Provider Finder®
- Register for or log in to Blue Access for MembersSM
- Call the Customer Service number on their ID card
Care for ongoing conditions: Members being treated for a pregnancy, disability, acute condition or life-threatening illness may have continuity of care benefits. This means they may still be able to see their current doctor at Saint Francis even after they leave our networks.
Benefits for continuity of care are based on benefit plans. To find out if they are eligible, members can call the number on their ID card for more information.
More Information: Contact your BCBSOK representative with any questions or concerns.
