By CRISTINA JANNEY
Hays Post
Hays Medical Center has yet to reach an agreement for a new contract with Blue Cross Blue Shield.
The hospital announced this summer it was negotiating with BCBS for higher reimbursement rates. If it did not receive higher rates, it said would terminate its contract with the insurer as of Dec. 31.
As the end of the contract approaches Hays Post reached out to both HaysMed and BCBS to answer questions about the contract negotiations and what will happen of the two entities fail to come to an agreement by the end of the year.
Can you please explain why the hospital decided to enter into these negotiations with Blue Cross Blue Shield to increase the reimbursement rate?
HaysMed: HaysMed and Pawnee Valley Community Hospital entered these negotiations to reach a fair, sustainable agreement that protects access to high-quality health care across western Kansas.
Since 2020, hospital costs have increased more than 27%, while BCBSKS has increased its payments to HaysMed by only 1% to 2% annually. BCBSKS also pays HaysMed significantly less than other hospitals for the same services.
HaysMed has worked to lower costs by moving hundreds of procedures to lower-cost outpatient settings and investing in more efficient care. However, these efforts cannot make up for years of low reimbursement.
We are reaching a critical point where maintaining all the services we provide today will become increasingly difficult without meaningful reimbursement increases over multiple years.
As the largest health insurance company in Kansas, BCBSKS has a responsibility to fairly reimburse the hospitals and providers its members depend on. Our goal is to reach an agreement that allows us to continue providing the specialized services western Kansas communities need close to home without having to stop offering those services in the future.
According to its 2023 Form 990, available through ProPublica, HaysMed had revenues of about $231.6 million but was $10.1 million short of expenses. In its 2024 Form 990 filing, the hospital's deficit had fallen to just less than $115,000.
Why won’t Blue Cross and Blue Shield offer equal reimbursement rates for HaysMed compared with larger metro hospitals?
BCBS: BCBSKS reimburses professional providers consistently across Kansas based on licensure and provider type. Hospital reimbursement varies based on facility capabilities and level of care, including trauma designation, bed capacity, specialty services, critical care capabilities and geographic location.
Why haven’t Blue Cross and Blue Shield reimbursement rates kept pace with the increasing cost of care?
BCBS: We do not agree with the premise of this question. BCBSKS reviews and updates its reimbursement methodologies annually, which is above and beyond standard industry best practice.
We do this by using established contracting methods and industry-standard coding frameworks. Hospitals also receive market-based adjustments through our ongoing contracting process.
While the financial terms of individual provider agreements are confidential, our approach is designed to fairly compensate providers while balancing affordability for our members and employer groups.
If costs to Blue Cross and Blue Shield policy holders are increasing, why aren’t reimbursement rates to the local hospital increasing?
BCBS: Reimbursement rates to local hospitals ARE increasing. There are other components to premium pricing, including prescription drugs, complexity and frequency of services and emerging technologies.
BCBSKS regularly reviews reimbursement and has continued to negotiate with HaysMed in good faith by proposing fair increases. Although the specific financial terms are confidential, we carefully evaluate reimbursement rate requests to balance fair compensation. When we pay more, members pay more.
How will I know if I am impacted by this negotiation?
HaysMed: If an agreement is not reached, and you are covered under a BCBSKS commercial plan, including Affordable Care Act Marketplace plans and out-of-state BCBS plans, your access to HaysMed, Pawnee Valley Community Hospital, and our doctors, providers and care teams might be impacted after Dec. 31. This will not affect patients with a Medicare plan or Healthy Blue Medicaid insurance through BCBSKS. Gove County Medical Center is not included in these negotiations.
In addition, emergency care will remain accessible to all patients regardless of this negotiation. Health plans are required by law to cover emergency services provided in any hospital emergency department at in-network rates.
Patients with certain serious conditions or critical care needs, such as but not limited to pregnancy, scheduled non-elective surgery, and terminal illness, may be eligible for continuity of care. Patients must apply for continuity of care through BCBSKS.
Has the hospital reached an impasse with BCBS?
HaysMed: No. Negotiations with BCBSKS are still ongoing, and no final decision has been made. HaysMed and Pawnee Valley Community Hospital are committed to continuing discussions and working toward a fair agreement that keeps care in-network.
BCBS: Blue Cross and Blue Shield of Kansas continues to negotiate in good faith with Hays Medical Center and remains committed to keeping the hospital in network. Our goal is to reach an agreement that fairly compensates HaysMed while protecting access to affordable care for our members.
If not, will the hospital try to continue to negotiate with BCBS? Will these negotiations go past the deadline in December?
HaysMed: HaysMed and Pawnee Valley Community Hospital remain committed to reaching an agreement with BCBSKS before Dec. 31, 2026, to avoid disruptions to patient care. We continue to work toward a resolution and hope BCBSKS shares that commitment.
Is there a possibility that an agreement could be reached after the deadline? Has that happened with other hospitals?
An agreement could still be reached after Dec. 31. However, our goal is to avoid that outcome by reaching a fair agreement before the end of the year.
Other hospitals in Kansas and across the country have gone out of network with Blue Cross and Blue Shield plans. In some cases, agreements were eventually reached, while in others, hospitals remained out-of-network.
We recognize that uncertainty about insurance coverage can be difficult for patients and families, particularly those receiving ongoing or specialized care. That is why we remain focused on reaching a resolution as soon as possible.
What percentage of HaysMed’s patients are insured through BCBS?
HaysMed: BCBSKS covers a significant majority of commercially insured patients in western Kansas, making these negotiations especially important to our communities. As the largest health insurance company in Kansas with almost 80% market share in western Kansas, BCBSKS should ensure patients can access the hospitals and doctors they depend on and that these services are fairly reimbursed given the large increases in inflation and health care costs.
Should community members continue to contact BCBS and encourage them to increase reimbursement to HaysMed and other rural hospitals?
HaysMed: Yes. Everyone’s voice is important in this discussion about health care access and affordability. Community members can play an important role in protecting access to local health care.
We encourage patients and families to contact BCBSKS at 1-800-432-3990 or the number on their insurance card and share why keeping HaysMed, Pawnee Valley Community Health, and their doctors in-network matters to them.
Community members can also visit HaysMed.com/BuiltForRuralHealthcare to send BCBSKS a prewritten letter.
How much of an increase was the hospital asking from BCBS? What is the estimated dollar amount that would mean for the hospital?
HaysMed: We are not permitted to share details while negotiations remain active. Our proposals are focused on reaching a fair, sustainable agreement that better reflects the rising cost of providing care and the significant reimbursement differences between HaysMed and Pawnee Valley Community Health and other hospitals.
We are seeking a multi-year agreement that provides greater stability for both organizations and supports continued access to primary and specialized health care services across western Kansas.
If the hospital had received the increase it asked for from BCBS, would its budget be balanced or in the green?
HaysMed: Yes. This assumes a multi-year deal above inflation for all the services and providers that we employ and offer.
We have implemented many cost-saving measures and moved many services to lower cost settings.
We have also invested in other health care facilities across Kansas to keep them open. However, we cannot continue to receive 1-2% increases when costs are going up substantially more each year. This is true for every site and every provider.
As the largest health insurance company in Kansas, fair reimbursement from BCBSKS is essential to our ability to keep pace with rising costs and continue investing in the people, technology and specialized services our communities depend on.
Do you anticipate a migration of patients away from HaysMed with BCBS out of network?
HaysMed: We don’t know what to expect. We have received amazing messages of support but know the out-of-network cost sharing might be too high for some patients.
Is there a concern that patients who might leave would not return to HaysMed even if the hospital reaches an agreement with BCBS at a later date?
HaysMed: That is a possibility, and we do not want to lose the relationships we have built with our patients and community members. However, without fair payment increases, we will not be able to continue to serve our communities in the same capacity in the future.
Has the hospital estimated how much money it will lose if it is no longer an in-network provider? What is that number?
HaysMed: Given our shared points above, our focus remains on reaching an agreement that protects patients’ access to care and supports the long-term sustainability of health care across western Kansas.
If HaysMed becomes out of network, what will be the closest hospital to Hays that remains in network?
BCBS: The closest in-network option will vary depending on the services a member needs and their specific health plan.
BCBSKS has the largest provider network in Kansas, with more than 95% of eligible hospitals and providers participating statewide. Members can use the BCBSKS provider directory or call the customer service number on their ID card to find appropriate in-network care.
Is HaysMed not being a network provider with BCBS an access issue for patients?
HaysMed: Yes. We have treated many of our patients for years and access is not readily available in other parts of Kansas.
This includes basic and primary care services. HaysMed also provides specialized services that many smaller hospitals in western Kansas cannot and do not offer, including cancer treatment, orthopedic care, heart care, higher level trauma care and treatment for serious lung conditions.
If HaysMed and PVCH become out-of-network, patients with affected BCBSKS commercial plans could face higher out-of-pocket costs or need to travel significantly farther for care.
We do not want that outcome for our patients or communities. That is why we continue to negotiate with BCBSKS to reach a fair, multi-year agreement that keeps care close to home.
What are the long-term ramifications of HaysMed not being an in-network provider for BCBS, both for the hospital and patients?
HaysMed: Our concern is for the patients we serve. HaysMed serves as an important regional resource for smaller rural hospitals that rely on our specialized services. Without fair reimbursement, we will likely not be able to maintain all the services we provide today.
From a practical standpoint, what will being out of network for BCBS patients look like for those who wish to stay with HaysMed? Pricing will be different, obviously. But will their billing and invoices be different? Will they need to manually request reimbursement for visits?
Patients may still be able to receive care at HaysMed and Pawnee Valley Community Hospital, but their insurance benefits and out-of-pocket costs could be different.
Patients should contact BCBSKS directly to understand their specific out-of-network benefits and potential costs. We will continue sharing information to help patients understand what these changes could mean for their care.
From a practical standpoint, what would being out of network mean for BCBSKS patients who wish to remain with HaysMed?
BCBS: A member’s coverage will depend on their specific health plan and benefits. Depending on their plan, members may have different out-of-pocket costs and billing requirements.
Emergency care will continue to be covered without an out-of-network penalty, and some members receiving treatment for serious or complex conditions may qualify to temporarily continue receiving in-network benefits.
For further details, please visit www.bcbsks.com/hays-med. We encourage members with questions about their coverage to contact customer service using the number on their ID card.
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