BlueCross BlueShield of Vermont headquarters in Berlin and The University of Vermont Medical Center in Burlington. Photos by Glenn Russell/VTDigger In a new public awareness campaign, BlueCross BlueShield of Vermont has joined four independent Chittenden County healthcare facilities in urging cl ients to seek less expensive care outside of Vermont’s large academic medical centers. The newly launched website, VT Affordable Care, offers a simple cost comparison for common medical procedures in different settings across Vermont. An MRI, for instance, costs the insurer $6,520 at UVM Medical Center in Burlington, while Northwestern Medical Center in St. Albans charges $2,785. At an independent facility that same service would be $1,799. A laboratory test at UVM costs almost $100 more than it would from an independent facility, where a test could be just $18.  By highlighting wide price gaps between hospital systems and independent providers, BlueCross BlueShield is urging Vermonters to see how the underlying cost of care shapes what they ultimately pay in premiums and frames patient choice as a key lever in keeping costs low. READ MORE “It should start people asking the question, ‘why?’ And when you start asking yourself the question of why, then you can start asking yourself other questions about, well, what can we do about it, and who is responsible? And is there a role I can play?” said Teresa Anderson, the insurer’s director of brand and engagement strategies. The effort is part of a larger push by the insurer to bring more attention to what it sees as the roots of the state’s healthcare affordability challenge. The insurer has faced solvency risks as the cost of claims has soared beyond the revenue it brings in through premiums. In 2024, the insurer paid out an average $35 million a week in claims; it left them $62.1 million in the red that year.  Vermonters spend a higher percentage of income on health insurance than any residents of any other state, according to a report published this summer. Vermont residents spent 19.6% of their income on insurance premiums in 2025; in New Hampshire that number is the lowest in the country, at 4%. The national average is 7.9% of income. BlueCross wants people to better understand the cost of these premiums — and it is asking for Vermonters help in keeping them down. “I think it’s important for people to understand that we’re all part of a pool, and the more responsibly we use resources ourselves, the better off the pool is,” said Andrew Garland, BlueCross BlueShield’s vice president of external affairs. Often, this true cost of care becomes obscured in this pool, explained Alex Garlick, a professor of policy at the University of Vermont. “Because insurance ends up picking up the bulk of the tab, consumers don’t really feel that cost, at least at the point of sale. It’s only later, in an aggregate sense, when premiums are going up and costs are going up, that patients feel this,” he said.  Garlick sees this effort as the insurer’s way to better communicate what’s behind such high premiums, the point where people do ultimately face the costs of healthcare.  “This is an effort to distance themselves from some accountability and saying, ‘you know, this is not a result of our profit margin,” Garlick said.  The fact that the company has been facing such financial precarity adds some credibility to the fact that they are probably not the primary driver of this trend, he added. The insurer instead points to the sheer cost of services as a driver of why healthcare does become so expensive here. For Garland, a recent example hit close to home. While working on this project, he encountered a health challenge and needed to schedule an MRI.  “I already met my deductible, so there’s no financial incentive for me to go to one place or another,” he said.  Nevertheless, he said he made an appointment at an independent facility, which was able to see him a week later.  “I saved my employer plan $3-4,000. That money, not being spent on this MRI, is now available for some other care. Every dollar we spend is going to end up impacting the rates next year,” he said. But, at the same time, it’s not something he’d advise everyone to do.  “It’s not right for everyone to get in the car and drive across the state,” he said. “I don’t want to discourage anybody from getting the care they need where they need to get it.” UVM Heath has taken notice but is keeping its head down. “We can’t really comment on BCBSVT’s marketing and advertising practices,” UVM Health spokesperson Annie Mackin wrote in an emailed statement. “We do support patients going to the lowest-cost setting that meets their care needs. And we believe that hospitals and insurance companies have the responsibility to work together to bring costs down for patients.”  The state’s largest hospital and the state’s largest insurer have long had a “simmering and ongoing adversarial relationship,” as the state-appointed independent healthcare liaison Mike Smith put it in an August letter to the Green Mountain Care Board and the Vermont Department of Financial Regulation, which regulate hospitals and insurers, respectively. Smith sat in on discussions between the two healthcare entities, during which they were meant to come to an agreement on lower commercial health insurance rates.  In that letter, Smith describes that BlueCross BlueShield has been reluctant to push back on the hospital network and negotiate lower prices out of fear that the hospital will refuse to see BlueCross BlueShield patients.  “Not providing care to BCBS-VT patients would be a disastrous situation for the insurance company, and it would be an equally disastrous situation for the (UVM Health network),” Smith wrote.  The hospital network, for its part, denied the allegation that it threatened to drop BlueCross  patients.  Part of the reason UVM Medical Center can have such leverage, explained Garlick, the UVM professor, is that it has a near monopoly on healthcare in the Burlington area. The three Vermont hospitals in the UVM Health network take in almost two-thirds of the total Vermonters spend at the state’s 14 hospitals, according to data from the Green Mountain Care Board. Dartmouth Hitchcock has its own relative monopoly for its service area, he added. “It’s kind of shocking to see the major academic medical centers charging multiples of what smaller facilities are charging, but in many cases, the major hospitals charge what the market will bear,” he said. “There are very few restraints on them charging such high prices, because the patients are going to come either way.” On the other side of the state, Dartmouth Health had yet to even learn of BlueCross BlueShield’s campaign. “We were not aware of this campaign and have not spoken with VT BCBS specifically about it,” the hospital network’s spokesperson Audra Burns wrote in an email to VTDigger. She reaffirmed the network’s commitment to keeping costs low, while maintaining high quality care. Many of the hospital’s rates reflect the range of more complicated care it provides, some of which are reimbursed below their cost, according to Burns.  She added that she and her colleagues did find the ad to be “ambiguous” regarding what types of independent facilities the insurer refers to that could even provide vaginal deliveries. Just this year, Vermont made it legal to build free-standing birthing centers, and an effort to erect the first is in the early stages of fundraising.  It’s unlikely, Garlick thinks, that UVM Health or Dartmouth Health will bring their costs down.  “So, how do you get out of this economic situation?” he asked. One pathway, he says, is through increasing competition and spreading some reliance onto other providers — exactly what BlueCross BlueShield is now pushing its beneficiaries to consider.  Still, the insurer insists that truly pulling costs down will be a collective effort.  “This is a problem that has been building for many, many years, and it’s not going to get fixed overnight,” Anderson said, citing needed action from within the health system, legislators and consumers. “It’s going to take all of those groups coming together to actually make a shift in what’s going on here in Vermont.” Read the story on VTDigger here: Vermont’s largest health insurer tells you to avoid the state’s largest hospital in new marketing campaign. ...read more read less