No settlement emerged Monday in a contract dispute that could force more than 60,000 patients with coverage from Blue Cross and Blue Shield of Minnesota to pay sharply higher out-of-network rates or seek care elsewhere.

A spokeswoman for Minneapolis-based Children's Minnesota said Monday morning that a "large gap" remained between the two sides, and there was no word by late afternoon about whether the health plan and hospital were any closer to an agreement.

Children's and Blue Cross are pushing a July 5 deadline, at which point tens of thousands of patients at Children's would face out-of-network charges for care at the hospital. In many cases, the charges could be prohibitively expensive.

On Monday, the lingering dispute had politicians offering to help, patients on edge and nurses lamenting the impasse.

"They're two big companies, they're fighting and patients are getting stuck in the middle," said Elaina Hane, a union leader with the Minnesota Nurses Association who's a nurse at the St. Paul campus of Children's. "It's unfortunate."

Blue Cross said it needs Children's to agree to Medicaid payment rates that are more comparable to other hospital systems. Children's counters that the proposed rates are too low and would force significant service cuts.

If an agreement can't be reached, Blue Cross said patients can be treated at other medical centers, but Children's contends other pediatric hospitals don't have sufficient capacity.

At the University of Minnesota Masonic Children's Hospital, which is one of the medical centers that Blue Cross is counting on as a substitute, officials Monday said the hospital is preparing to care for patients and make transitions "as seamless as possible."

"While we do not offer specialized hemophilia treatment, we do offer similar range of services and even some that others locally do not, including solid organ transplant and bone marrow transplant," Christopher Lemme, an executive with University of Minnesota Health, said in a statement.

Beyond patients losing in-network access to Children's, about 670 pediatric doctors and nurse practitioners who are part of the hospital's network of clinics and outpatient centers also would become out-of-network for Blue Cross subscribers. Even with the loss, Blue Cross said 81 percent of pediatricians will remain in-network.

The contract dispute would not directly impact subscribers' ability to obtain outpatient care at in-network rates from about 700 doctors and health care providers in the Children's Health Network — a group of clinicians who are affiliated with, but not employed by, the pediatric hospital.

"Many of those clinicians have such close ties to Children's that conducting care may be challenging," the hospital said Monday in a statement. "For example, many utilize Children's specialists [or] they send their patients to Children's for imaging studies."

Blue Cross and Children's have been working over the past several weeks to make sure that patients in the midst of complex treatments can continue their care for a period of time, even if a contract deal isn't reached. Last week, a Blue Cross official said the insurer had granted 120 days' worth of continuing coverage for more than 4,000 patients.

Contract disputes between hospitals and health insurers usually settle before patients experience a disruption, but the Blue Cross-Children's impasse is pushing later than other recent disputes in the Twin Cities. When Blue Cross and Fairview Health Services were at odds over contract terms last year, for example, they reached an agreement more than two weeks in advance of a Jan. 1 deadline.

The Blue Cross-Children's fight has been unusually public. Both sides have laid out their arguments in dueling newspaper ads, and Children's launched a social media campaign to garner support under the slogan #standtallforsmall.

Last week, Lt. Gov. Tina Smith contacted the chief executives of Blue Cross and Children's and told them Gov. Mark Dayton stood ready to help if requested.

"She was told last week that the two sides were still working toward an agreement, but was not requested to become involved," spokesman Sam Fettig said in a statement Monday. "The Lt. Governor and the Governor both know that there are a great many Minnesota families whose children's health depends upon a successful resolution to these negotiations."

Angela Mineo of Plymouth was among those hoping for a settlement. She's been taking her daughter, who's almost 2, to a clinic owned by Children's for routine care and is dismayed by the prospect of finding a new pediatrician.

"You select your providers very carefully from day one," she said. "When you're in a place that you really feel good about, and you're in a network that works well for you, it's not a small process to change."

Twitter: @chrissnowbeck