AUSTIN (KXAN) – Blue Cross Blue Shield of Texas says 66,000 of its insured patients received care at Ascension hospitals and surgery centers over the past year – contract negotiations ongoing between the companies could terminate access to these health facilities if there is no agreement.
A statement from Ascension Texas to KXAN indicates that the current agreement with Blue Cross Blue Shield of Texas will end at the end of January.
This would put more than 50 hospitals, centers and surgery centers out of the network for patients in and around Austin, as well as Waco. The Dell Children’s Medical Center is one of them.
We contacted the hospital system after several policyholders messaged us at ReportIt@KXAN.com.
The statement said in part: “Without a commitment to reasonable terms, our current agreement with BCBSTX will end on January 31, 2023 for commercial and Medicare Advantage members of BCBSTX.”
KXAN also received a statement from Blue Cross Blue Shield of Texas indicating that this change would impact more than 60,000 patients – starting with the exclusion of Ascension hospitals on February 1, eventually excluding physicians and the health personnel by mid-summer.
The statement said in part: “To protect our members, we have submitted a notice of termination to Ascension for physicians and healthcare professionals employed by Ascension. If we cannot reach a reasonable agreement, doctors will leave the Blue Choice PPO, Blue Essentials and Medicare Advantage (PPO) networks on May 1. Physicians and healthcare professionals will also leave the Blue Advantage HMO network on June 15. ”
Both companies encourage members to verify their coverage using the policy information on their member ID cards.
“I feel like a pawn”: patients caught in a contract battle
Claire Tapscott is thrilled to be a new mom. Her birth plan includes delivering her baby girl at Ascension Seton Hospital, but an email from the health system on Monday sent her into panic. His plan was in trouble.
“I just went into panic mode, trying to figure out, is my doctor going to be covered?” Will hospitals be covered? said Tapscott.
After calls to BCBSTX, she learned that the hospital of her choice as of February 1 would no longer be covered by her insurance without the companies agreeing to a partnership.
Her OBGYN would still be covered, but Tapscott says she wasn’t sure if she had hospital privileges at other area hospitals.
This gave her two options: stay with her doctor at the risk of paying out-of-network prices at another hospital, if there were even privileges — or find a new OBGYN, healthcare team, and hospital for a month. after her due date.
“I am 34 weeks pregnant. And I love my doctor, I don’t want to find a new doctor. I feel like a pawn, I feel like patients are pawns in this conversation,” Tapscott said.
BCBSTX accepts “continuity of care” applications – this allows members being treated for pregnancy, disability, acute illness, or life-threatening illnesses to receive in-network rates at Ascension facilities if they leave its network.
The insurance company asks members to verify their eligibility by calling the number on their ID card.
Although doctors and medical professionals will not be removed from the network until May 1 and again on June 15, Michael Wilson, father of three, says he is worried.
One of her children suffers from a chronic illness that requires regular visits to specialists. He says this change would take his child away from the doctor who already knows his needs and treatment.
“I think the big entities are fighting, it seems like the patients are the ones who kind of get stuck in the middle,” Wilson said.
BCBSTX provided this Web page for updates on ongoing negotiations. Ascension has also provided its own Web page.
Both Ascension and BCBSTX say they are working to reach an agreement.
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