KNOXVILLE, Tenn. — Editor's Note: This story has been corrected to reflect patients did not lose the ability to access in-network coverage after some patients said they were told they'd have to pay extra out-of-pocket costs.
Some patients at East Tennessee Children's Hospital Urgent Care locations may have recently heard that the clinics would no longer be considered in-network for BlueCross BlueShield of Tennessee and they would need to pay more money for treatment, but the companies said patients are still covered in-network.
Contract negotiations between the insurance company and the company that operates the four clinics — TeamHealth — created confusion over patients' in-network status. The four locations are located in Blount County, Sevier County and two in Knox County.
BCBS said TeamHealth did go out-of-network, but said it was able to work with ETCH to bring the urgent care providers back in-network.
"If a BlueCross member was turned away or told they would face higher costs, it was a mistake. We'll work with ETCH to make sure this doesn't happen again," BCBS said.
Those negotiations came at a time when the CDC warns flu cases could rise significantly in Tennessee, and when RSV cases are already rising. As a result, more people may pay a visit to an urgent care clinic soon.
Bethany Crabtree is insured through BlueCross BlueShield. She said that her 5-year-old daughter got sick recently, and so they took her to the urgent care clinic.
"They told me they were not sure what the cost would be," said Crabtree. "They would send me the bill in the mail."
Some other parents who went to the clinic said they were also told their insurance would not cover the visit and they would have to pay out of pocket. However, the emergency room at the East Tennessee Children's Hospital was not part of the contract negotiations — it is still covered.
"Just had to make a decision. Either I let my child be seen and incur more expenses out-of-pocket using my out-of-network benefits, or I take her to the ER, and I didn't want to do that because the ER is already overburdened. Or I took her to an urgent care that didn't specialize in pediatrics," said Crabtree.
The East Tennessee Children's Hospital said that they apologized for any confusion the contract negotiations caused. They also said that as flu season gets underway, they are already experiencing an influx of patients to the emergency room.
They also said that regardless of a patient's ability to pay, they are still treating people at all locations — including their urgent care clinics.
"We will continue to go there, even though they can't reach an agreement with BlueCross BlueShield, which is no fault of their own," said Crabtree.
Dalya Qualls White, the chief communication officer for BlueCross BlueShield of Tennessee, released a statement. It is below.
“We want to assure BlueCross commercial members they do have in-network access to care at East Tennessee Children’s Hospital Urgent Care locations.
We’re disappointed that our negotiations with TeamHealth led to some confusion and want to provide some additional background.
The providers who serve at these urgent care clinics were previously in our commercial network through their contracts with TeamHealth. When it became clear TeamHealth would be out-of-network, we worked to bring these providers in-network through our contract with East Tennessee Children’s Hospital. (Physicians often have employment contracts with multiple provider groups and health systems.)
We are always focused on making sure BlueCross members have access to quality care at affordable prices.”
