By Tim Bonfield
The Cincinnati Enquirer

About 3,000 area families are waiting to find out whether Cincinnati Children's Hospital Medical Center can make a deal with Medical Mutual of Ohio.

A three-year contract between the organizations expires at midnight.

Parents started getting nervous after receiving a letter dated April 19 from the hospital warning them that they could wind up responsible for higher "out-of-network" medical bills if no agreement can be reached.

Now, both sides say that families will not face paying higher out-of-network fees even if no deal is reached.

"There should be almost no effect on the patient. We are going to continue to negotiate," said Jerelyn Pinkham, Medical Mutual's lead negotiator for physician contracts in the southern half of Ohio.

Echoing a letter the company sent this week to area insurance brokers, Pinkham said Medical Mutual members "will not be subject to out-of-network penalties or to balance billing."

Even if the contract deadline passes, Medical Mutual plans to treat members as if they still are covered for care at Children's Hospital and its staff doctors. But the insurer will send checks to families who would then have to pay the hospital or doctors.

A shift to out-of-network fees - which Children's Hospital had said was possible - could mean families would have to pay 50 percent of a hospital bill instead of 20 percent. Actual amounts would vary by employer, but the shift could expose people to thousands of dollars in unexpected bills.

Despite assurances that families won't be harmed, Park Hills, Ky., resident Jenni Wessels said she remains very concerned about whether Medical Mutual will pay for a planned June 10 surgery for her 2-year-old son, Evan.

He suffers extensive heart and abdominal problems from a rare condition called Noonan's syndrome.

The family estimates that Evan's medical bills since he was born already have cost hundreds of thousands. Even with coverage, the family pays more than $25,000 a year for insurance premiums, co-payments and uncovered supplies and services.

"We have seven different doctors for Evan. We get so many bills we have to use a computer spreadsheet to keep it all straight," Wessels said. "All of this is very disturbing."

The contract dispute appears to revolve around doctor pay. Talks have been going off and on since December.

Medical Mutual, which reported improved profits in 2003 on a 15 percent increase in overall revenue, says Children's Hospital has asked for an unacceptable 89 percent increase for some of its staff doctors.

Hospital spokesman Jim Feuer said its proposed contract seeks an overall increase of about the same amount that other insurers, including Humana and Anthem Blue Cross and Blue Shield, have agreed to pay.

He also said that Medical Mutual pays local pediatric specialists 60 percent to 90 percent less than similar doctors get in Columbus, Indianapolis and other cities.

E-mail tbonfield@enquirer.com