Ascension Texas hospitals may no longer be part of the network for people with Blue Cross and Blue Shield of Texas plans starting February 1st.
Patients receiving care at Ascension hospitals and insured by Blue Cross and Blue Shield of Texas received a letter this week from Ascension outlining the possible consequences.
Who got hurt?
Blue Cross and Blue Shield of Texas estimate that 66,000 of their members sought medical care at Ascension Hospital in Central Texas last year. These members include employees of the City of Austin, employees of the University of Texas, government employees, and people who receive insurance through the Teachers’ Retirement System. Blue Cross and Blue Shield of Texas is the largest insurance company in the state with over 6 million members.
This potential change will affect people who have Blue Choice PPO, Blue Essentials, Blue Advantage HMO, and Medicare Advantage (PPO) plans. This does not affect Blue Cross and Blue Shield Medicare Advantage (HMO) and Medicaid networks in Texas.
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What does offline mean?
Most people with Blue Cross and Blue Shield of Texas plans will have to pay for out-of-network services if they choose to go to Ascension Hospital. Off-network verses affect how high the deductible is before insurance starts paying, and this affects your maximum out-of-pocket spending – the amount at which, once you reach it, the insurance company starts paying 100% of the costs. They vary in plan, but in many cases the difference in deductibles and cash limits doubles, costing families thousands of dollars.
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What hospitals are included?
This affects care at these hospitals and their clinics – Dell Seton, Ascension Seton, Dell Children’s, Ascension Seton Southwest, Ascension Seton Northwest., Ascension Seton Hays, Ascension Seton Williamson, Ascension Seton Bastrop, Ascension Seton Smithville, Ascension Seton Highland Lakes in Burnet. , Ascension Seton Edgar B. Davis in Luling and Ascension Providence in Waco.
Most of the 2,400 doctors working at Ascension Seton hospitals will not be affected, as they have separate contracts with the insurance company that only expire in May or June, depending on the plan. This does not affect Ascension Seton Shoal Creek Psychiatric Hospital due to a different contract, but does affect all clinics attached to Ascension Seton Hospitals.
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Why is this happening?
Hospital systems and insurance companies regularly renegotiate contracts before renewing them. Negotiations between Ascension Seton and Blue Cross and Blue Shield of Texas have been ongoing since the fall. The contract, which was a multi-year one, is valid until January 31st.
“We’re not at an impasse,” said Shara McClure, vice president of medical care at Blue Cross and Blue Shield of Texas, “we keep talking, keep coming back with offers.”
Ascension Texas, which includes Ascension Seton hospitals in Central Texas and Ascension Providence in Waco, declined to answer questions about the talks and their impact on patients. He provided a written statement:
“We are committed to extending our Blue Cross Blue Shield of Texas (BCBSTX) agreement with reasonable and updated contract terms to help Central Texas members continue to access our unique combination of high quality, cutting edge, and affordable services. Ascension Texas continues to work with Blue Cross Blue Shield of Texas under a contract that will provide BCBSTX policyholders with network access to Ascension Texas hospitals, physicians and hospital clinics, including the Dell Children’s Medical Center, and selected joint venture facilities, including outpatient surgery . centers. Without being bound by reasonable terms, our current agreement with BCBSTX will expire on January 31, 2023 for BCBSTX Commercial and Medicare Advantage members.”
Ascension Texas’ 11 hospitals posted $399.6 million in operating profit in 2021, according to the National Academy of Public Health Policy’s report on Hospital Costs and Resources. According to Best’s credit report, the Health Care Service Corporation group, which owns Blue Cross and Blue Shield of Texas, had a net income of $3.889 billion in 2020.
McClure of Blue Cross and Blue Shield of Texas said the differences between him and Ascension Texas are related to service reimbursement rates, which McClure says are “a lot of money”, “many, many millions”.
Blue Cross and Blue Shield of Texas have offered to increase coverage, but “so far, their demands have been higher than we’re willing to pay,” McClure said. She said that compared to the other two hospital systems in the area, St. David’s HealthCare and Baylor Scott & White Health – Ascension Seton “is already the most expensive system on the market” and “Dell Children’s is one of them.” of the highest in the state.
The hospital system and the insurance company are also battling over some of the language in the contract that McClure said would prevent the insurance company from conducting claims checks to make sure bills are updated accordingly.
Blue Cross and Blue Shield of Texas said they would also not be able to offer plans that exclude Ascension hospitals, which they may want to do.
“We want to preserve sovereignty,” McClure said.
Patients are involved in all this. “We hope to come to an agreement,” McClure said. “That would help with anyone’s anxiety.”
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Are there exceptions for leaving the network?
There are situations that can still be covered under Blue Cross and Blue Shield of Texas on-network rates, McClure said.
If someone has an emergency or injury and is in a facility that is off the network, it is considered to be on the network, she said.
If someone is in the process of being treated for a chronic illness, a life-threatening situation, or an acute situation, or has just had surgery and is undergoing follow-up, or if they are pregnant and have an established relationship with the hospital and doctor at that hospital, these cases may be considered ” continuous care” and can be used to obtain intranet coverage.
If there are services that can only be provided at an out-of-network hospital in Central Texas, they may be provided in-network after approval.
If an agreement is not reached on Feb. 1, but is reached shortly thereafter, it is possible that Blue Cross and Blue Shield will give people caught in the gap on-grid rates. It has happened in the past, McClure said.
What can Blue Cross and Blue Shield members do?
Blue Cross and Blue Shield of Texas and Ascension encourage people to call the insurance number on the back of their card to check coverage and out-of-pocket expenses before a scheduled procedure or health check at an affected hospital or before visiting a clinic that may be affected.
Ascension also provided the health.ascension.org/BCBSTX website. and phone number 833-620-0183 for more information.
