Ascension, Blue Cross Blue Shield dueling over Texas coverage

A major Texas health care network and a major Texas insurance company continue to battle over a new contract. Failure to reach a deal by the end of the month could mean fewer in-network options for thousands of Central Texans.

The fighters are Ascension Texas, parent of Ascension Providence in Waco, and Blue Cross and Blue Shield of Texas. At risk are patients who have coverage through Blue Cross and want or need treatment at an Ascension-brand hospital or surgery center in the state, including Waco.

Ascension Texas said in a statement that it continues to negotiate contract terms “that will ensure BCBSTX policyholders maintain network access to Ascension Texas hospitals, physicians and hospital-based clinics, including Dell Children’s Medical Center , and selected joint venture facilities, including Ambulatory Surgery Centers.”

The statement says that “without a commitment to reasonable terms” Ascension’s agreement with Blue Cross will end Jan. 31 for Commercial and Medicare Advantage members.

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Ascension Texas is urging patients to contact Blue Cross and Blue Shield of Texas for details on how their coverage may be affected, instructing them to use the number on the back of their insurance card “to voice concerns.” .

Blue Cross and Blue Shield, meanwhile, says it is working to reach an agreement that will keep costs under control.

“We value the care Ascension provides to our members, but it is already one of the most expensive health systems in the Austin and Central Texas area,” Blue Cross and Blue Shield of Texas said in a statement. “As a leader in the customer-owned health insurance industry in Texas for more than 90 years, it’s important to stand up for affordable care, especially at a time when most of our businesses and members in the Austin and Central Texas region they are facing inflationary pressures and a possible recession”.

Without an agreement, Ascension’s physicians would be removed from the Blue Choice PPO, Blue Essentials and Medicare Advantage networks on May 1, and physicians and health care professionals would leave the Blue Advantage HMO network on June 15, according to the statement.

Blue Cross and Blue Shield of Texas opposes Ascension over its rapid expansion in Texas in recent years. He specifically mentions Ascension Seton Health System, which serves Austin, saying, “It has acquired multiple specialty groups and ambulatory surgery centers, immediately increasing costs for patients of those acquired physicians and facilities.”

“Studies show that health care consolidation leads to higher prices and does not necessarily lead to better quality care for our members,” the statement said.

He says Blue Cross “is willing to pay fair rates, but our members should not expect to make up the shortfalls that Ascension has in other states.” He notes that Ascension is headquartered in St. Louis. Louis and has more than 2,600 care centers, including 139 hospitals in 19 states.

Blue Cross and Blue Shield of Texas, meanwhile, calls itself the state’s largest health benefits provider, “working with nearly 80,000 physicians and health care practitioners and 500 hospitals to serve 6 million members in all 254 circles”.

The Austin American-Statesman reported that 66,000 people with Blue Cross and Blue Shield of Texas insurance used Ascension Hospital or Clinic services last year.

Blue Cross said that if an agreement is not reached, it will do everything it can “to help members move their care to quality, cost-effective, in-network hospitals and health care professionals.”

Her statement says emergency or trauma services at any hospital, regardless of an existing contract, are covered at in-network rates for Blue Cross members.

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