When the chief financial officer of Lovelace Health Plan looks at Santa Fe's only major hospital, his accounting goes haywire.

The per-patient costs at Christus St. Vincent Regional Medical Center are 30 percent higher than his next busiest hospital in New Mexico. When he looks at the top seven hospitals that claim reimbursement from Lovelace, Christus is twice the cost of No. 7 on the list.

And so, when the private, nonprofit Christus was asking for more increases, Lovelace balked. "We felt we could not accept that for the people we represent," said Lovelace executive Frank Ulibarri.

As a result, since last weekend there is no contract between Lovelace and Christus. That means the 14,000 Lovelace insurance customers in Santa Fe County can no longer access the hospital for elective care, nor can they seek treatment at the Christus-owned clinics or physician offices such as the Arroyo Chamiso Pediatric Center and Camino Entrada Pediatrics, among others.

Emergency care and current Christus hospital patients are not affected.

Ulibarri maintains Christus is abandoning its mission of providing care for everyone. "It seems to be inconsistent with a Christian-based nonprofit mission," he said. "It was simply, 'this is what we want; this is what we'll give you.' "

The insurer sought to extend the existing contract for 30 days to better inform patients. And the sides were close to a deal on reimbursements for clinics and physicians as well as an agreement for the 3,500 Salud Medicaid patients. "We were extremely close. We could have moved on the things we agreed," Ulibarri said.

Christus executives say they've been talking to Lovelace since April of 2009 and gave a 90-day notice of expiration. When Lovelace rejected a counteroffer Friday night, the insurer didn't come back seeking other provisions. "We received a 'No,' said Dr. Alex Valdez, a former state health chief who is now the Christus St. Vincent CEO.

Valdez said the hospital agreed to resume talks with Lovelace, "and they will be face to face," with the time and place still being arranged.

Meantime, both sides are finalizing a protocol for what constitutes continued care so Lovelace interim coverage can continue for some pregnancies, cancer treatment and radiation services.

As far as the higher costs, Valdez said it depends on the procedures, but no one doubts that Santa Fe is more expensive than elsewhere in New Mexico.

"We have a higher wage that we support, and we are compensating at that wage or higher," he said. He added that Christus has concluded contract talks with Presbyterian Health Plan and has contracts with every major insurer in Santa Fe.

Anne Sperling, an insurance broker with Daniels Insurance who works with business owners on employee coverage, said Lovelace is the smallest insurer still writing coverage in Santa Fe. She said Christus St. Vincent, which is largely a monopoly, should welcome Lovelace's lower-cost premium option because it provides insurance to those who would not have it otherwise.

"I'm appalled that our local hospital can't come to an agreement with Lovelace," she said.

She understands Christus has been pinched by government reimbursements, but "it's an insult to Santa Feans that we have a sole-community provider that is screwing their community," she said of the hospital.

Lovelace has received some 200 calls on its Santa Fe hot line asking for physician referrals or transportation to Española or Albuquerque for medical services, and the company is offering to provide those rides.

"From our standpoint, this is the worst-case scenario. This is the last thing we would ever want to happen," said Ulibarri.

Wayne Propst, executive director of the New Mexico Retiree Health Care Authority, doesn't care who is at fault. He has 500 state retirees in Santa Fe who now have to go to Española or Albuquerque for hospital care and other services.

He was especially not pleased at the short notice — and squarely blames Lovelace for the lack of notification. "If we'd had even two weeks, we could have reached out and given our members information," he said.

"We hope this is short-lived and reasonable minds will reach a reasonable agreement," Propst added.

Ulibarri said the insurer thought it was close enough with Christus on key provisions that it made sense to keep talking until the final contact day, which was Friday. Talks might have been complicated, he said, because all the communication went to Christus executives in Texas, not Santa Fe.

One Santa Fe mother whose 11-year-old son is in the Salud Medicaid program couldn't wait. She switched to Blue Cross Blue Shield on Monday as her child has an appointment at the Christus-owned Camino Entrada Pediatrics on Sept. 1.

The woman said she was not happy with the way Lovelace gave almost no notice and, as a working mom, she can't possibly look for a new doctor. "He has allergies, he needs specialized care, he needs to see his doctor," she said of her son.

CEO Valdez acknowledged that Christus has grown since the merger, adding physician and specialty offices. The hospital issues some 2,000 paychecks and has more than 100 doctors for some 200 in-patient beds. It will hire a fourth neurosurgeon soon and be able to provide 24-hour coverage. "You're going to continue to see us investing and growing our footprint," he said.

The impact of this growth may be more scrutiny, he said. Business owners concerned about insurance costs, as well as patients, may be frustrated by the Lovelace stalemate, but "I am comfortable that we are negotiating in good faith and we look forward to getting back to the table for resolution."

Sperling shares that hope. "It's horrible," she said, "asking the sick, the injured and the old to drive to Albuquerque" for medical care.

Contact Bruce Krasnow at brucek@sfnewmexican.com.