Austin (KXAN) – 66,000 downtown Texas residents are still waiting for a resolution to ongoing contract negotiations between a major hospital system and one of the state’s largest insurance companies after learning they could lose access to nearby facilities. One local insurance consultant said pressure is usually part of the negotiation process.
Last week, Ascension patients, insured by Blue Cross and Blue Shield of Texas (BCBSTX), reported receiving reports that they could lose in-network coverage to the hospital system if the companies were unable to reach an agreement by the end of this month.
Ron Nemec is an insurance broker with 15 years experience in Buda helping individuals and small businesses navigate the health insurance market.
He says his office has received several calls and emails related to a health juggernaut dispute.
Nemets says steps such as notifying patients of potential coverage changes so close to the agreement deadline are fairly typical of the negotiation process.
When the alarm is sounded, there is more pressure on companies to make a deal, he said.
“Because they will receive calls from their group carriers, they will receive calls from their individual consumers who are interested in this. And I think that creates some pressure in the negotiation window,” Nemets said.
The German said the process could cause patients to panic, despite the fact that most agreements are made at the last minute. While expected, he said it might seem unfair to policyholders caught in the middle.
“If you go to a certain oncologist or your child is being treated at Dell Seton for a certain rare disease, I find it unfair to change these contracts in the middle of the year,” Nemec said.
New statement from Blue Cross and Blue Shield of Texas
BCBSTX has released an updated statement regarding its relationship with Ascension.
So the provider says it’s still working in good faith to reach an agreement, but claims the healthcare system is trying to make up for lost profits in other states by raising prices in Texas.
The statement reads in part:
Ascension Seton is part of Ascension, one of the nation’s largest healthcare systems. Ascension is headquartered in St. Louis and has over 2,600 healthcare facilities, including 139 hospitals in 19 states. Nationwide, Ascension posted an operating loss of around $1 billion, despite an increase in operating revenue of $738 million.
While healthcare operating costs have increased due to inflation and labor shortages, Seton remains profitable in Texas despite Ascension’s larger portfolio of hospitals. BCBSTX is willing to pay fair rates, but our members should not be expected to add to the shortcomings Ascension has in other states.
Ascension has been expanding aggressively over the past two years. He purchased several specialist teams and ambulatory surgery centers, which immediately increased patient costs for purchased doctors and equipment. Research shows that health care consolidation leads to higher prices and does not necessarily result in a better quality of care for our members.
While we will continue to negotiate in good faith, we want to assure BCBSTX members that we are committed to reaching an agreement that will keep them accessing Ascension facilities at a fair price.
Blue Cross and Blue Shield of Texas