Kent Hospital and Women & Infants Hospital sent letters this week to nearly 40,000 recent patients describing the contract dispute between the hospitals’ parent company, Care New England, and Blue Cross & Blue Shield of Rhode Island.

The letter warns that “you will be forced to pay more money out of pocket to continue receiving care at our hospital” and urges patients to contact the Health Department, Blue Cross and their employers.

At issue are contract negotiations over how much money Blue Cross will reimburse the hospitals for care. The current contract expires Dec. 31, and if the two sides can’t reach agreement, then Care New England hospitals (which also include Butler Hospital, a psychiatric hospital) will no longer be in Blue Cross’ network. That has never happened.

If the Care New England hospitals are dropped from the Blue Cross network, most subscribers could still go to those hospitals, but they’d have to submit their bills to Blue Cross and pay the difference between Blue Cross rates and hospital charges.

Spokesmen for both sides said yesterday that they are negotiating a possible contract extension that would give them more time to resolve their differences.

Meanwhile, the two sides are still talking. “They report to me that they’re in conversations but remain pretty far apart,” said Christopher F. Koller, the state’s health insurance commissioner.

“Both parties need one another. I don’t think a situation where Women & Infants is out of network benefits Women & Infants or Blue Cross or Blue Cross members who use their services. … We expect the parties to get back to the table and resolve their differences and not put patients in the middle of their conflicts. That said, it’s important for patients to be informed about what their benefits are.”

Certain Blue Cross plans do not have out-of-network benefits. Those patients would not have coverage for care at the three hospitals, except for certain specialty services or in emergencies.

Blue Cross spokesman Christopher J. Medici said that both sides share a strong desire to keep Care New England hospitals in the Blue Cross network. He called the hospitals’ letter “unfortunate.”

“We’re very much trying to calm everyone’s fears,” he said. “We want to assure everyone, members and providers, that we are optimistic and hopeful that we will reach a new agreement.”

May Kernan, Care New England spokeswoman, described the mailing as “an informational effort.” Failure to reach agreement, she said, “will have a dramatic effect on how health care is delivered in this community. Lots of patients will be disenfranchised. We have a responsibility to advise them of that.”

These contract negotiations typically occur away from the public eye –– until difficulties arise and one side or the other seeks public sympathy.

In this case, the parties went public very early. In June, Blue Cross filed an application with the Health Department detailing how it would cover patients without Care New England hospitals. In October, Care New England sent letters notifying doctors and other constituents that it might not reach an agreement by Dec. 31. The most recent letters, dated Nov. 3, reach out to a wider group.

The Health Department will soon begin reviewing Blue Cross’ proposal for covering its subscribers without Care New England hospitals. After the public comment period ends on Nov. 13 and the department determines that it has all the information it needs, the department has 90 days to act.

For Care New England’s point of view, see the company’s update at www.carenewengland.org/body.cfm?id=289.

For recent comments on the dispute from Blue Cross president James E. Purcell, go to www.bcbsri.org.

ffreyer@projo.com