photo by: LMH Health

LMH Health, 325 Maine St., is pictured in May 2021.

A financial battle between Lawrence’s only hospital and the state’s largest health insurance network has left thousands of area residents uncertain about whether they should keep their longstanding health insurance plans for 2022.

But University of Kansas employees and other State of Kansas workers have been given a temporary reprieve on figuring out whether Blue Cross Blue Shield of Kansas and LMH Health will reach a deal for 2022. State of Kansas officials have extended the open enrollment deadline for signing up for the state’s health insurance program to Nov. 5. The deadline previously was set for Oct. 31.

The extension gives what is likely thousands of Douglas County households extra time to consider how to proceed with health insurance in 2022. State and KU workers have two health insurance options to pick from: Blue Cross Blue Shield of Kansas or Aetna. BCBS of Kansas, as the largest insurer in the state, has been the top choice for many in the plan, but a primary reason behind that choice is that virtually every doctor and hospital in the state is included in the BCBS network.

If LMH Health and BCBS of Kansas don’t reach a deal before Dec. 31, that won’t be the case at all in Lawrence in 2022. LMH Health, in addition to operating the city’s only hospital, owns the largest number of doctor’s offices and specialty clinics in the county.

Without an agreement, the hospital and those health care offices would be considered out of the BCBS of Kansas network. That would mean that BCBS of Kansas customers could still receive care at those facilities, but they would be charged higher prices than if they were in network.

State of Kansas officials, recognizing the large number of state employees who live in Douglas County, extended the 2022 enrollment deadline by a few days to give more time for the impasse to potentially get resolved.

On Monday, there were no signs that the two parties were closer to reaching an agreement, but a spokeswoman with LMH Health confirmed more negotiating sessions are scheduled for this week.

“We are colleagues together, and this is something we want to work out,” Amy Northrop, a spokeswoman for LMH Health, said of the hospital and BCBS of Kansas.

At issue is how much BCBS of Kansas will pay LMH Health for the types of services it provides to patients. LMH leaders say they have used federally mandated websites that show how much hospitals received from insurers for certain procedures to know that LMH is receiving less than many hospitals in the region.

BCBS of Kansas has not directly addressed how it determines whether to pay one hospital more for a particular service than another hospital. Rather, the company has put out a statement saying that LMH Health’s request was “dramatic” and “stunning” and would result in Douglas County health care consumers paying millions more for their care.

LMH leaders, though, have pushed back on those statements, saying it is not a given that BCBS of Kansas would have to increase premiums to pay better rates to LMH Health. Instead, BCBS simply could reduce its profit margin that it receives from Douglas County customers.

BCBS of Kansas has countered that it has a responsibility to do its part to help control health care costs for all.

Neither side, though, has released specific dollar figures about how far apart the two parties are in negotiations. The Journal-World on Monday again asked for such information from LMH. Northrop said she didn’t have any specific numbers to share, but rather pointed to an example LMH Health found as part of its online research.

In the example, LMH said that an area hospital (it didn’t specify which one) was being paid 25% more for the same procedure (it didn’t say what procedure) than what LMH Health was being paid. LMH Health said it wasn’t trying to get a rate equal to what the other hospital was being paid, but rather proposed a rate that would have still been 15% less than what the other hospital was paid. LMH said BCBS of Kansas rejected that proposal.

It wasn’t clear, though, how representative that one example is of the entire negotiating process. In prior years’ negotiations, LMH shared that it was expecting to take about a $4 million revenue hit related to new BCBS of Kansas rates. But LMH hasn’t said whether that $4 million total is accurate for this year’s negotiations.

What LMH has said is that BCBS of Kansas is its largest private insurance payer and that any reduction would have an outsized impact on the finances of the nonprofit hospital.

On Monday, neither side did much to extend the back and forth. Instead, Northrop, of LMH Health, said she thought the extension of the state’s open-enrollment period was a positive development.

“I would view that as helpful for our patients and community members,” Northrop said. “It gives them time to do more research about what their options are.”

A spokeswoman for Topeka-based BCBS of Kansas said the company was looking forward to completing the negotiations.

“We’re actively working to resolve the negotiations, and we want LMH as a continued partner,” Katrina McGivern, a spokeswoman with BCBS of Kansas, said. “The conversations between LMH and BCBSKS over the past few days have been constructive and amicable. We are communicating with our members about their benefits and will work to make sure our members’ health care needs are met.”

LMH leaders also did attempt to address several frequently asked questions about the process, including which Blue Cross Blue Shield customers are at risk of being knocked out of network in 2022.

In general, state and university employees are at risk, along with people who work for a private employer who uses BCBS of Kansas. Also at risk are people who have purchased a BCBS of Kansas Medicare Advantage Plan, which is a type of insurance plan that is essentially an enhanced version of the federal Medicare insurance program.

A different type of Medicare customer, however, is not currently at risk of getting knocked out of network. LMH has said customers with a BCBS of Kansas supplemental Medicare plan — often known as a Medigap Plan — are not impacted by these contract negotiations. The Medigap plan is under a different contract with LMH Health.

Other Blue Cross Blue Shield companies, such as BCBS of Kansas City or various BCBS companies located in other states, are not impacted by the current contract negotiations, LMH Health said.