Health officials say demands for higher reimbursement rates have caused contract negotiations between Texas Health Resources and Blue Cross Blue Shield of Texas.
THR asked to extend its contract with a 4 percent increase from BCBSTX, however, the health insurer was offering a 2 percent increase. It’s a difference the insurance company said could potentially cost them $57 million.
The insurance company plans to drop THR’s dozens of hospitals and emergency centers, as well as its hundreds of outpatient clinics, from its network Jan. 1, unless the two organizations reach a new contract by the end of the year.
“Unfortunately, despite our best efforts we have not reached agreement with THR,” he said. “So, starting on Jan. 1 their facilities will no longer participate in some Blue Cross and Blue Shield networks in Texas. This means you’ll face higher out-of-pocket costs when you visit one of their facilities and there’s no guarantee for a better member experience.
“It also means you’ll probably get a bill for additional costs that aren’t covered by your policy. This is disappointing and something we’ve worked for several months to prevent. Health care is a major expense for most families and we owe it to our members to do everything we can to keep prices down. Our members expect us to be a good steward of their health care dollars.”
Texas Health Resources CEO Barclay Berdan said Blue Cross waited to substantively engage until deep into the open enrollment period, knowing that Texas Health’s contract expires Dec. 31.
“Blue Cross finally put an offer on the table for a two percent increase, then rescinded it [Monday],” he said. “We had offered to extend this contract with a modest 4 percent increase.
“While our actual costs are increasing at a rate of more than 4 percent, we were, and remain, willing to accept a reasonable increase.”
Berdan said health plans around the country have been demanding from providers, reflecting a shift in how health care delivery is being transformed across the country.
“We have repeatedly pointed out to BCBSTX that we do not want to negotiate this contract renewal in public,” he said. “Their continued delays place patients, their employers and their physicians in the middle of this and may ultimately and significantly disrupt their care. This need not have happened.
“Texas Health provides in excess of $1 billion in services to BCBSTX members each year. Any figures BCBSTX uses is an effort to grab headlines, and should be taken with a truckload of salt.”
López said BCBSTX’s only priority is to help its members experience as little inconvenience as possible as they change to other quality credential health care providers in our networks.
“One question we’ve heard frequently is, ‘What do I do if I have a procedure scheduled on or after the termination date?’’ he said. “If you find yourself in this situation, please contact our customer service team at the phone number on the back of your member ID card another question.
“Continuity of care allows members with certain health conditions to continue to get treatment through this provider and have their claims paid as in network,” he said. “Some examples of circumstances that might be eligible for continuity of care include a member receiving treatment for disability, an acute condition, life-threatening illness or a member who has passed the 24th week of pregnancy.”
Sharon Rich shared her thoughts about the issue on the Times-Review Facebook page.
“Sounds like the insurance company is holding the clinics and hospitals hostage for more money,” she said. “Medical cost are ridiculously high due to the insurance companies. If you don’t think so … just ask your primary provider how much they charge for a visit when you offer cash. It’s less than half, but they try to justify the cost for handling your insurance paperwork. Think about that for a moment. Just my opinion but I’ve seen it happen.”
THR remains hopeful they can extend a contract with BCBSTX for at least another year.
“We remain committed to reaching an agreement with BCBSTX before the end of the year regarding an extension so that we can continue providing the high-quality, compassionate care for which we are well known,” Berdan said. “This, we believe, would be in the best interests of patients, physicians and the community.”
Date: December 07, 2016