Two major North Texas medical systems are no longer in-network for Blue Cross and Blue Shield of Texas insurance plans, including commercial plans, as well as Medicaid and Medicare Advantage plans.
The insurance company failed to come to an agreement with Southwestern Health Resources, which includes the medical providers and hospitals at Texas Health Resources and UT Southwestern. The contracts between Blue Cross and Blue Shield of Texas and Southwestern Health Resources expired on Tuesday, according to both entities.
A statement from Southwestern Health Resources, sent over email by spokesperson Kimberly Walton, described the insurance company as unmoving during negotiations.
“Despite months of negotiations, BCBSTX remained unwilling to accept Southwestern Health Resources’ requests for equitable reimbursement to cover the rising costs of providing quality care,” the statement said.
In an emailed statement on Tuesday afternoon, Blue Cross and Blue Shield of Texas said the insurer is “sensitive to the difficulties hospitals are facing with labor, supply, and other cost pressures.”
“Unfortunately, we couldn’t reach an agreement that protect[s] the interests of our members and customers, who are facing those same pressures,” the statement said.
Both entities said in their statements that they still hope to reach an agreement.
There are seven affected health insurance plans, according to the insurance company’s website:
- ParPlan
- Blue Choice PPO
- Blue Essentials
- Blue Advantage HMO
- Medicaid
- Blue Cross Medicare Advantage (PPO)
- Blue Cross Medicare Advantage (HMO)
A spokesperson for the insurance company declined to say how many people were impacted by the change.
Options for patients
On its website, the insurance company said it will work with impacted people to find in-network medical providers.
Insurance plan members can look for new providers online through the insurance company’s “provider directory,” or they can call the number on their ID card.
Patients can also opt to continue seeing their existing medical providers at out-of-network costs. This option typically involves higher out-of-pocket costs.
In some cases of insurance or provider changes, people with complex or serious diagnoses may qualify for “continuity of care,” which allows patients to remain with their existing medical providers at in-network prices for a specified amount of time.
The insurance company also posted on its website that, in emergency cases, people should still call 911 or go to the nearest emergency medical center.
“Emergency services for commercial networks are covered at the in-network benefit level,” the insurance carrier’s website says.
Editor’s note: This article has been updated to include comment from Blue Cross and Blue Shield of Texas.
