Saturday, May 1, 2004

Children's, Medical Mutual without contract at deadline

By Tim Bonfield
The Cincinnati Enquirer

A contract between Cincinnati Children's Hospital Medical Center and Medical Mutual of Ohio was expected to expire at midnight Friday without the two sides reaching an agreement.

About 3,000 families covered by Medical Mutual get care from Cincinnati Children's. Despite no contract, both sides say families will not face paying higher out-of-network fees.

Instead, the insurer will send checks to the families, which they can use to pay for services. Talks are expected to resume Monday, but neither side would predict when an agreement might be reached.

Contract talks between hospitals and insurers often come down to the last few days before a deadline. But only rarely do contracts expire without a deal.

In one recent exception, tens of thousands of Greater Cincinnati residents were caught in the middle when a contract expired Dec. 31 between Anthem Blue Cross and Blue Shield, the region's biggest insurer, and the Health Alliance of Greater Cincinnati, the area's largest hospital group.

The two sides agreed to terms Jan. 9. During the gap, the Health Alliance avoided potentially massive disruptions in care when it agreed to serve Anthem members as if the hospitals were still part of the insurer's network.


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