Tens of thousands of Texans could potentially be affected by a major conflict between the state’s largest insurance company and one of the nation’s largest health care networks, with many providers and facilities excluded from the patient network. Negotiations have been going on for months without a solution, and now time is running out.
The contract between Blue Cross Blue Shield of Texas (BCBSTX) and Ascension Texas will expire on January 31st, causing hospitals such as Dell Children’s Medical Center, Dell Seton Medical Center at the University of Texas, and 10 other Texas hospitals to be taken offline. if a new contract is not signed, as per the notice issued by Ascension.
“Over the past several months, Ascension Texas has been negotiating with Blue Cross Blue Shield of Texas to secure and adequately reimburse the vital medical services it provides to BCBSTX members in Central Texas,” the notice reads.
An additional 32 hospital-based hospitals and 10 joint venture hospitals and ambulatory surgery centers will be affected, primarily in the Central Texas and Hill Country regions. A complete list of affected items and information can be found on the Ascension website.
“We are committed to extending our Blue Cross Blue Shield of Texas agreement with reasonable and updated contract terms to ensure that its members in Central Texas can continue to access our unique combination of high quality, cutting edge and affordable services,” Ascension Texas said in a statement. . in a statement to MySA.
Ascension claims that “current market conditions and inflationary pressures” are not taken into account in insurance companies’ contractual terms.
“We are negotiating in good faith and are committed to an agreement that will continue to provide BCBSTX members with access to Ascension facilities at a fair price,” BCBSTX said in a statement to MySA. “We appreciate the care Ascension provides to our members, but this is already one of the most expensive healthcare systems in Austin and Central Texas.”
The nonprofit Ascension had nearly $18 billion in cash reserves, according to a New York Times report on the company’s downsizing in recent years. As of September 30, 2021, BCBSTX has invested approximately $27 billion in assets, including approximately $1.9 billion in cash and cash equivalents, according to the latest financial reports on the website of BCBSTX, also a non-profit organization.
BCBSTX serves approximately six million Texans and is the primary health insurance option for approximately 328,000 people working in the state at any given time, as well as many eligible family members. Retired civil servants with at least 10 years of service are also eligible for state medical benefits.
In total, according to the Texas pension system, one in 54 Texans, or more than half a million people, is insured by the state.
An ERS spokesperson told MySA that the statewide organization is currently monitoring the situation, also noting that in most cases such contract disputes are resolved.
Otherwise, Ascension hospitals will no longer be covered by the Blue Choice PPO, Blue Essentials, Blue Advantage HMO, and Medicare Advantage PPO networks effective February 1. A Notice to End Coverage has also been sent to Ascension BCBSTX for physicians and other health care providers. caregivers hired by the medical group.
“If we cannot reach a reasonable agreement, physicians will leave the Blue Choice PPO, Blue Essentials, and Medicare Advantage PPO networks on May 1,” BCBSTX said in a statement. “Physicians and healthcare professionals will also leave the HMO Blue Advantage network on June 15th.”
However, Ascension Hospitals will remain in the HMO Medicare Advantage and Medicaid networks. In addition, people covered by BCBSTX who are being treated by Ascension for a pregnancy, disability, acute condition, or life-threatening illness may qualify for on-net rates as continuing care patients.
Both organizations encourage those covered by BCBSTX to call the customer support number on their ID, whether looking for a new service provider or contacting any company’s help desk.
Chris O’Connell of MySA provided coverage for this story.
/cloudfront-us-east-1.images.arcpublishing.com/dmn/YSSOOUON5VB3LGZ2MBA23CGB2Y.jpg)
