Shockwaves are rippling through health care circles in southeastern Michigan as the news that a contract dispute between University of Michigan Health and Blue Cross Blue Shield of Michigan could bump roughly 300,000 patients out of network with Michigan Medicine providers, clinics, health centers and hospitals as soon as July 1.

Unless negotiations result in a new, five-year contract by June 30, hundreds of thousands of people could be hunting for new primary care physicians and specialists.

It’s sparked questions about whether other metro Detroit hospital systems will have the capacity to absorb that influx of patients — many of whom have rare diseases, chronic and critical conditions — and what it might mean for wait times for new appointments and medical services in this corner of the Mitten, and more.

Here’s what you need to know:

Who will lose in-network access on July 1?

Without a deal by June 30, Michigan Medicine patients with commercial Blue Cross Blue Shield of Michigan insurance plans and Blue Care Network coverage will have to pay out-of-network prices starting July 1 if they seek nonemergency care at the following hospitals and health centers affiliated with U-M Health’s academic medical center:

• University Hospital in Ann Arbor

• C.S. Mott Children’s Hospital in Ann Arbor

• Von Voigtlander Women’s Hospital in Ann Arbor

• D. Dan and Betty Kahn Health Care Pavilion and Frankel Cardiovascular Center in Ann Arbor

• W.K. Kellogg Eye Center in Ann Arbor

• Associated physicians and outpatient clinics, including the Briarwood Medical Group, the Livonia Center for Specialty Care, the West Ann Arbor Health Center, the Canton Health Center, the Chelsea Health Center, the Detroit Riverview Center, the Livonia Health Center, the Northville Health Center and the Ypsilanti Health Center.

Medicare Advantage and Medicaid plans are not part of the contract negotiations, nor is the U-M Health Plan that covers employees, faculty, staff, and retirees. Those plans are not affected.

The dispute also does not affect U-M Health-Sparrow and U-M Health-West hospital systems, or the physician group U-M Health Partners.

Are U‑M students covered at campus health clinics?

Unless an agreement is reached, students who have commercial Blue Care Network or Blue Cross Blue Shield plans will have to seek treatment elsewhere or pay for out-of-network care, said Gabby Abel, public relations manager for Blue Cross Blue Shield of Michigan.

“As part of Michigan Medicine’s choice to terminate their contract with Blue Cross, University of Michigan students with a BCBSM or BCN plan will be directly impacted,” Abel said. “If we are unable to come to a compromise, unfortunately, U-M students would lose in-network access to University Health & Counseling (UHC) services effective July 1.

“We recognize how frustrating this can be, especially for busy students, and we are ready to help them find alternative care. Students with questions can receive help by calling the number on the back of their member ID card.”

What if I have a medical emergency in Ann Arbor? Can I go to a Michigan Medicine hospital?

Yes. Emergency medical care will continue to be covered in-network for Blue Cross plan holders.

“Even if we are unable to reach an agreement by July 1, emergency care will always be covered as in-network,” said Mary Masson, senior director of public relations for Michigan Medicine in a March 4 email message to the Detroit Free Press.

Who qualifies for continuity‑of‑care extensions?

Some Blue Cross members will be eligible for a 90-day “Continuity of Care” extension of in-network coverage, Abel said.

Examples of patients who would qualify for that are people with cancer, terminal illness, cardiovascular disease, diabetes, autoimmune disorders, Alzheimer’s disease, those who have had an organ transplant, or are pregnant.

Blue Cross also will extend in-network coverage for 90 days for members who have a serious and complex condition, which is defined as:

• An acute illness serious enough to require specialized medical treatment to avoid the reasonable possibility of death or permanent harm.

• A chronic illness or condition that is life-threatening, degenerative, potentially disabling or congenital and requires specialized medical care over a prolonged period of time.

Others also may qualify, such as patients who are:

• Undergoing a course of institutional or inpatient care from the provider or facility.

• Scheduled to undergo nonelective surgery from the provider, including receipt of postoperative care.

• Pregnant and undergoing a course of treatment for the pregnancy from the provider or facility.

• Is or was determined to be terminally ill (as determined under section 1861(dd)(3)(A) of the Social Security Act) and is receiving treatment for this illness.

If you think you might qualify for continuity of care services, ask your medical provider to initiate a continuity of care request or call the number on the back of your member ID card to ask for assistance.

“One of the reasons we began member notifications about Michigan Medicine’s decision to terminate is because the hospital system cares for people with very complex, life-threatening conditions and we wanted to give those people as much notice as possible,” Blue Cross’ Abel said in an email message to the Free Press.

More: Michigan Medicine patients losing sleep over BCBSM contract dispute

More: Blue Cross, Michigan Medicine dispute puts 300K patients in limbo

“However, after those 90 days end the provider or facility would then be out-of-network and alternative care would need to be arranged. As we continue to negotiate with Michigan Medicine, we encourage members to not wait it out, and to find care with an alternate in-network provider or facility to ensure the least amount of disruption as possible.”

What does out‑of‑network mean for costs?

If patients are treated at a hospital, clinic or by a medical provider who isn’t operating under a negotiated contract with their health insurance plan, then it is considered “out-of-network” care, which usually comes at a much higher cost.

How much higher is dependent on a number of factors, Abel said.

“Usually, members using out-of-network providers or facilities can expect to pay double the usual in-network cost,” she said. “For members with an HMO plan, they do not have any out-of-network benefits and would absorb 100% of the cost. For members with PPO coverage, they would pay their out-of-network benefit, which is usually double.”

If negotiations fail, is it a qualifying life event so I can change my insurance plan?

Insurance companies consider some life events significant enough to allow participants to change their policies midway through a plan year. They’re called qualifying life events, and can include a marriage or divorce, being fired or laid off from your job and having a child.

Abel said, however, that if contract negotiations with Michigan Medicine fail, this would not trigger a special enrollment period for members.

“Michigan Medicine choosing to leave the BCBSM/BCN network is not a qualifying life event,” she said.

Can other Michigan hospitals manage a surge of displaced patients?

It’s uncertain. Already, patients in the region report that it can take months to schedule appointments for certain services or to see specialty health care providers. The state also is in the midst of a primary care physician shortage.

Shelly Weiss Friedberg, director of public relations for Tenet Healthcare, which owns the Detroit Medical Center, said it is ready to accept Michigan Medicine patients who could lose in-network care.

“The DMC has capacity and the ability to expand access to our services to meet the needs of patients in our community,” she said. “In addition, BCBS plan members will continue to have access to the highly specialized pediatric care offered at Children’s Hospital of Michigan with our high acuity capabilities.”

Corewell Health told the Free Press it’s also preparing to do its part.

“Contracts between health care systems and insurance providers can be challenging,” said spokesperson Mark Geary. “Corewell Health and other systems will always do whatever we can to help patients navigate insurance paperwork to provide high quality care to patients. “

Trinity Health Michigan spokesperson Bobby Maldonado issued the following statement:

“Trinity Health Michigan regularly manages changes in patient volume, and we are committed to timely and high-quality access for anyone seeking care,” he said. “With more than 400 sites of care and nine hospitals across Michigan, we operate an integrated statewide network, anchored by the Trintiy Health national system, designed to meet the needs of our patients and the communities we serve.”

Could the Michigan Department of Insurance and Financial Services help to resolve this dispute?

The state Department of Insurance and Financial Services says it does not have authority over contract negotiations between health systems and insurance providers.

Its spokesperson, Chelsea Lewis, declined to comment on the Blue Cross-Michigan Medicine dispute, saying: “We do, however, encourage both parties to return to the negotiating table for the benefit of Michiganders.

“Patients should contact their insurer and review their policy terms to understand any potential impacts to their care or to begin an appeal if a coverage denial occurs,” she said. “Under the Patient’s Right to Independent Review Act, Michiganders are entitled to a free, impartial, expert review of final health insurance claim denials to ensure they receive the health care services they are owed.

“DIFS provides free assistance with these reviews, working with independent outside experts to help ensure Michiganders receive the medically necessary care they deserve.”

Anyone with questions or concerns about health insurance policies can contact DIFS at 877-999-6442 between 8 a.m. and 5 p.m. Mondays-Fridays or visit Michigan.gov/DIFScomplaints.

Will Michigan Medicine and Blue Cross reach a deal before July 1?

Allan Baumgartner, an independent analyst and consultant who publishes the annual Michigan Health Market Review, said it that if past precedent is any guide, it is likely the two sides will come to an agreement.

“Almost all of them do get resolved — almost all of them in the 11th hour,” he told the Free Press.

That was the case for Trinity Health and Aetna when negotiations went down to the wire and settled just before a Dec. 31, 2024, deadline that would have bumped patients with Aetna insurance plans out-of-network across the Livonia-based health system’s Catholic, nonprofit hospitals, clinics and providers in about two dozen states nationally.

However, even though Baumgarten estimates about 90% of these disputes end in an agreement, some haven’t fared so well — that includes contentious negotiations between Corewell Health and United Healthcare.

In January, a stalemate in contract negotiations between Corewell Health’s legacy Beaumont hospitals in southeastern Michigan and United Healthcare terminated in-network coverage for patients at hospitals in Dearborn, Taylor, Trenton and Wayne.

United Healthcare said in a post dated March 4 on its website that it continues to be “actively engaged in good faith discussions with Corewell Health (Corewell) to renew our network relationship. Our goal is to reach an agreement that is affordable for the people and employers we serve while maintaining continued, uninterrupted network access to the health system.”

If a deal can’t be reached before May 1, Corewell Health Farmington Hills Hospital-employed providers could also become out-of-network for United Healthcare patients. And without a contract by July 1, Corewell Health William Beaumont University Hospital, Corewell Health Troy Hospital and Corewell Health Grosse Pointe Hospital also would become out of network.

In Florida, Baumgarten said, Blue Cross Blue Shield hit an impasse with two Broward County hospital systems: Broward Health and Memorial Health Care.

“Both of them, as I understand it, have been out of network for several months now with Blue Cross Blue Shield of Florida,” Baumgarten said.

Here in Michigan, both U-M Health and Blue Cross say they are continuing discussions with an aim of making a deal.

Because Michigan Medicine is the state’s only academic health system and the sole provider of many complex services in the state, Masson said, the health system is “fighting so hard to ensure patients continue to have the same level of access to these critical health services. We’re asking BCBSM to agree to the reasonable and fair reimbursement terms we’ve offered. Patients deserve peace of mind.”

Andy Hetzel, vice president of corporate communications for Blue Cross, said in a statement: “We also stand ready to continue our contract negotiations — and we are committed to finding ways to provide payment to the Michigan Medicine system that is responsible and affordable.”

Contact Kristen Shamus: kshamus@freepress.com. Subscribe to the Detroit Free Press.

This article originally appeared on Detroit Free Press: Michigan Medicine vs. Blue Cross: What patients need to know now