Less than six weeks before their contract expires, one of the largest health care providers in North Texas and the state’s largest health insurer are still negotiating for 2014.
If no agreement is reached by the end of the year, most of HCA’s facilities, including Medical City Dallas Hospital, will be considered out of network as of Jan. 1 for those covered by Blue Cross Blue Shield of Texas. For the insured, using an out-of-network provider is more costly than in-network.
HCA also operates medical centers in Plano, Denton and other North Texas locations.
The company said its ambulatory surgery centers are on different contracts that do not expire on Dec. 31.
“In the meantime, we are negotiating in good faith and continuing to provide the same quality care we are known for to our community,” HCA said in a statement.
“Emergency care, of course, is always available regardless of insurance plans,” said HCA, based in Nashville, Tenn.
Blue Cross Blue Shield chief medical officer Dan McCoy said he was hopeful the organizations could reach an agreement, but said the reimbursement increases HCA seeks are too high.
“They are nearly four times the rate of inflation and would add nearly $100 million annually to the cost of care for our members in Texas,” he said. At the time negotiations began, according to BCBSTx, the rate of overall inflation was running at a little over 1 percent annually.
Such negotiating disputes between providers and insurers are not uncommon.
In mid-November of 2010, Arlington-based Texas Health Resources and BCBSTx said they were still negotiating and warned that if no agreement could be reached, THR facilities would be considered out of network.
A month later, the two sides said they reached an agreement.
HCA declined to provide anyone to be interviewed about the negotiations but did answer some emailed questions:
Does this extend to HCA facilities beyond the North Texas division?
Yes, this is a statewide contract.
Does this affect your urgent care facilities, free-standing emergency departments and ambulatory surgery centers?
North Texas Division ambulatory surgery centers are on different contracts that do not expire on Dec. 31, 2013. The urgent cares and free-standing ERs are included in this negotiation.
What are you telling patients?
We have notified physicians of the status of our negotiations and are informing patients appropriately.
Date: 22 November 2013