Texas

Blue Cross and Blue Shield of Texas may not cover Ascension Texas network hospitals starting next month.

Starting next month, more than 60,000 people in Central Texas will be unable to access their health insurance from one of the region’s largest hospital systems.

Ascension Texas hospitals may no longer be part of the network for people with Blue Cross and Blue Shield of Texas plans starting February 1, unless the insurance company and hospital can agree on a new contract.

Blue Cross and Blue Shield of Texas is the largest insurance company in the state with over 6 million members. This includes University of Texas employees, government employees, and people who receive insurance through the Teachers’ Retirement System.

Nicole Villalpando, who handles health care at Austin American-Statesman, said there is no need to panic for Ascension Texas patients with Blue Cross just yet.

“It’s actually very standard. Every couple of years, hospitals and insurance companies need to negotiate their agreements,” she said. “They have been negotiating since the fall and are far from reaching an agreement, but they are working on it. There is hope that this will resolve itself by February 1.”

If an agreement is not reached, people with Blue Cross and Blue Shield of Texas plans will not lose all of their health care. Instead, Villalpando said they would have to pay for offline services on the Ascension sites. In some cases, this can double the cost of a visit to the doctor.

Ascension hospitals include the Dell Children’s Hospital and Dell Seton at the University of Texas, and the Providence Ascension Clinic at Waco.

Ascension Texas patients with Blue Cross recently received a letter alerting them to the possibility of an upcoming change in coverage. Villalpando said it was partly a bargaining tactic.

“In a way, it was a chance to inform the public about what was going on. But the letter came from Ascension, and it really was: “Let’s ask the people who may be affected, that is, patients, let’s get them to start calling Blue Cross Blue Shield.” Because Ascension, of course, gave you the number to call and told you how to call. And it really was ‘let’s get the public to put some pressure on Blue Cross Blue Shield’ to start negotiations in a way that benefits Ascension.”

Villalpando said she didn’t get to talk to anyone at Ascension Texas, but she had lengthy conversations with Blue Cross and Blue Shield of Texas.

“They told me that Ascension is the hardest organization to negotiate. They are also the hospital system in Central Texas that charges the most and has the highest costs,” she said. “Ascension wants them to rise in price even more. So here’s the problem. It’s all about the money.”

Villalpando said there was a good chance an agreement would be reached by the February 1 deadline or shortly thereafter. However, if an agreement is not reached, she said, patients with current treatment plans can still pay in-network costs as required by law.

“A person who is in this situation where you are in the process of getting help should call Blue Cross Blue Shield of Texas to make sure they can get continuous care,” she said. “This is the actual law, so they should be able to provide it to them.”

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