Negotiations over a requested increase in rates broke down between Children's National Medical Center and CareFirst, the Washington, D.C. arm of BlueCross BlueShield on Nov. 1. That evening, CareFirst issued a press release slamming the hospital for what it called an "excessive rate increase request." Since then, both sides have launched aggressive campaigns to reach consumers, including paid advertising in local publications and on the air. But Children's has remained relatively reactive in its PR approach, with no press releases, nothing on its online press center and no proactive outreach to local media.