A contract with Bayhealth and Highmark is set to expire May 15th, leaving many members at risk of having to pay out-of-network fees if a new contract is not reached before that date.
Bayhealth and Highmark’s relationship dates back to 1982, when Highmark used to be known as Blue Cross Blue Shield of Delaware.
Highmark’s President Tim Constantine says they’ve been trying to re-negotiate its contract for five years, and Bayhealth claims that what they’ve been presented with is not fair.
Bayhealth’s CEO Terry Murphy says he received notice in January that Highmark would be cancelling the group’s longstanding agreement.
“What they want to pay us for what we do – we do expect to be paid fairly for the care that we provide patients in Kent and Sussex Counties. So it really relates to the fact that they have asked for significant cuts," Murphy said.
When asked how significant the cuts in reimbursements for Bayhealth would be, Murphy said in the ballpark of $21 million: $13 million in reductions for outpatient services and $8 million in reductions for inpatient care.
Highmark does not agree with those figures. Instead, Constantine insists the company is dedicated to providing affordable healthcare for Delaware residents.
"The renegotiation was really focused on the rising cost of care and the demand, quite frankly, from our customers to provide access to more cost-effective care," Constantine said.
Both parties say they are committed to working together to reach an agreement, but neither would say when that might happen. The two side do agree a lot of negotiation will be needed to bridge the gap.
If an agreement is not reached before May 15th, Murphy says many residents in Kent and Sussex counties may have to travel longer distances to access care, or pay higher out of pocket costs.
“This is disruptive to patients. Patients and their relationship with their doctors and nurses in the hospitals is a very, very special relationship," Murphy said.
