Infant receives life-altering surgery as negotiations continue between MLH and BCBST
MEMPHIS, Tenn. (WMC) - After a back-and-forth between Blue Cross Blue Shield and Le Bonheur Children’s Hospital, a seven-month-old received life-altering surgery Thursday.
Nathan suffered from bacterial meningitis, and if he did not receive bilateral cochlear implant surgery, he would permanently lose his hearing.
As we reported Wednesday, Nathan’s parents, Tyler and Melanie, were informed that Le Bonheur could no longer move forward with the surgery because their insurance was through Blue Cross Blue Shield of Tennessee (BCBST), which is no longer accepted at Methodist Le Bonheur Healthcare (MLH) facilities, which includes Le Bonheur Children’s Hospital.
This is due to the two healthcare giants failing to come to a compromise and renew a new contract by the Dec. 31, 2022 deadline.
The Harts are among thousands of Mid-South patients who are now uncovered in the MLH network.
Wednesday evening, however, the Harts were then informed that Nathan would receive surgery and that it would be covered by BCBST.
The next morning, as if this hasn’t already been an emotional roller coaster for this family, the Harts told us that the surgery was no longer covered.
“The doctor came in and said it’s not covered, but we’re doing the surgery,” Melanie Hart said.
Little Nathan entered the operating room late Thursday morning and came out around 3 p.m., surgery successful.
Adding another emotional loop to this story, the Harts said they got a call from Blue Cross Blue Shield North Carolina.
They were covering the operation.
“Relief,” Melanie said plainly. “Tears of joy... we can breathe now.”
There will still be some medical bills for the Harts to pay, but it will be significantly cheaper than the roughly $120,000 it would have been as an out-of-pocket expense.
The Harts represent thousands of families across the Mid-South, and the country, for that matter, who are dealing with this issue between Blue Cross Blue Shield and major U.S. hospital networks.
To the south in Jackson, MS, the University of Mississippi Medical Center (UMMC) and Blue Cross Blue Shield of Mississippi (BCBSMS) were at odds over a contract dispute for over eight months, starting April 1 of this year.
Only recently, on Dec. 15, did the two groups agree to a contract extension.
The issue in Memphis revolves around the medical rates the BlueCross customers pay at MLH facilities.
Methodist confirmed to Action News 5 that BCBST is asking for a 40% rate reduction from its current rate, which the hospital network has gone on record saying this ask is “unreasonable.”
The last contract proposal presented in these ongoing negotiations was on December 20, and there’s no indication on when another proposal will be presented and if it will be agreed to or not.
For the Harts, they understand that there are other families at Le Bonheur who, so far, have not been as lucky as them.
“There are other people’s surgeries that have gotten canceled,” said Tyler Hart. “I’ve seen a couple of them this morning.”
For now, this family will count their blessings as Nathan is set to be discharged from Le Bonheur on Friday with his healing intact.
The Harts have set up a GoFundMe to pay for any expenses insurance does not cover.
The Harts said the first thing they’re doing when they’re discharged is going home to rest because “sleeping in a hospital for 21 days has been rough.”
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