KYLE MURPHYStaff Writer

Starting in January 2025, Vanderbilt University Medical Center (VUMC) will no longer be accepting BlueCross BlueShield of Tennessee’s (BCBST) Medicare Advantage plan.

The decision came about this summer when both BCBST and VUMC reached a new long-term network agreement which would make sure BCBST members, with either employer-based or individual coverage in both P and S Networks, will continue to have access to care at all Vanderbilt Health providers, as well as will organ transplant patients. Per VUMC, enrollees in the BlueCare plan and organ transplant patients are covered under separate agreements. 

“This agreement with BlueCross BlueShield is integral to our mission to serve the health care needs of millions of Tennesseans, providing added continuity and stability for the relationship between our organizations,” said C. Wright Pinson, MBA, MD, Deputy Chief Executive Officer and Chief Health System Officer for VUMC. “We look forward to working closely with our BlueCross colleagues as we continue to serve our patients and their members.”

However, BCBST’s Medicare Advantage plans were not part of the agreement, which was a mutual decision.

“Beginning Jan. 1, 2025, patients who are currently enrolled Blue Advantage members and have received care at a VUMC facility or from a VUMC health care provider will lose in-network access,” VUMC officials said. “We are working collaboratively with BCBST to communicate with patients now, prior to the change, and assist them as needed. Patients will receive information from both VUMC and BCBST about steps they can take during the upcoming fall open enrollment period.”

VUMC joins the growing list of medical providers who are dropping Medicare Advantage plans. According to “Becker’s Hospital Review” while Medicare Advantage provides health coverage to more than half of older adults in the country, 27 health providers have thus far dropped Medicare Advantage plans, including VUMC. The report added excessive prior authorization denial rates and slow payments from insurers are among the most commonly cited reasons for dropping the plans.