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Mission, BCBS contract dispute hits local families hard

Eight-year-old Holmes Desmelik has a smile on his face and two parents who adore him. He’s lucky that way. But in another way, he’s facing something a little boy should never have to face. Holmes has an inoperable brain tumor. (Photo credit: WLOS staff)

The insurance contract between Mission Health and Blue Cross Blue Shield (BCBS) has officially ended, and some patients are already feeling the impact.

Eight-year-old Holmes Desmelik has a smile on his face and two parents who adore him. He’s lucky that way. But in another way, he’s facing something a little boy should never have to face. Holmes has an inoperable brain tumor.

His health struggles come at a time when Blue Cross Blue Shield and Mission Health cannot come to terms on a new contract. Holmes’ health care coverage and potential out-of-network costs are looming as an unknown, even as his mom Clare and dad David worked in the months leading up to the Oct. 5 contract deadline to avoid having any surprises.

“Holmes having brain cancer, of course, is a huge deal to us, to have him continue with his doctors,” said Clare Desmelik.

“Them, not being able to figure out a deal is just affecting, not just us, but so many families,” David Desmelik said as their son sat with them to talk about the potentially huge out-of-pocket costs they may face in coming months.

In the weeks leading up the deadline, Mission CEO Dr. Ron Paulus publicly assured cancer patients their care would be covered by what’s been called a continuity of care policy. However, that policy has proven to be a moving target, with no guarantees of what will, or won’t, be covered.

“The continuity of care, only includes his oncologist,” said Clare.

“The radiology and scans he gets done every 12 weeks, nurse practitioners, may not be covered,” David said about this son’s health insurance.

The family is insured under the Affordable Care Act, and the only available policy in North Carolina was with Blue Cross.

“If he's suffering from headaches or something, we want to get to Asheville,” said Claire. “We want to be around doctors that he is comfortable with.”

Understandable, but now, there’s no guarantee that those bills will be paid by Blue Cross. While a Mission spokesperson said Mission does administer the continuity of coverage plan, there’s no guarantee that Blue Cross will reimburse now, and that would mean the Desmelik family could be on the hook for tens of thousands of dollars unless the two sides strike a deal soon.

The Desmelik family isn't the only family grappling with the continuity of care policy.

Sharon Riddle works part time delivering flowers for a local Asheville shop. She said she had an appointment Thursday morning for a mammogram at a Mission Cancer Center, near Asheville Outlets. She said the check-in person was nearly in tears when she told her she could not be seen.

"She said they're not going to cover it. I said they told me, made sure when I made the appointment today, that I would be covered today," Riddle recalled. "And she double checked, and she said, 'I know. Case of miscommunication'."

Sharon said she made her appointment months ago. Knowing about the deadlock between Mission and BCBS, she said she repeatedly checked in with a Mission representative, who assured her she could still get her mammogram on Thursday.

However, that information turned out to be wrong.

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