Blue Cross Blue Shield could cut Ascension Seton providers

Tens of thousands of Texans could potentially suffer from a major collision between the state’s largest insurance company and one of the nation’s largest health care networks, taking many providers and patient facilities out of network. Negotiations have been going on for months without a solution and now the clock is running out.

A contract between Blue Cross Blue Shield of Texas (BCBSTX) and Ascension Texas will expire Jan. 31, leaving hospitals such as Dell Children’s Medical Center, Dell Seton Medical Center at the University of Texas and 10 other Texas hospitals out of network if a new contract has not been signed, according to a statement released by Ascension.

“For the past several months, Ascension Texas has been negotiating with Blue Cross Blue Shield of Texas to ensure and appropriate reimbursement for the vital health care services it provides to BCBSTX members of Central Texas,” the release said.

An additional 32 hospital-based clinics and 10 shared hospitals and ambulatory surgery centers will be affected, primarily in the Central Texas and Hill Country regions. A full list of affected facilities and information can be found on the Ascension website.

“We are seeking to renew our Blue Cross Blue Shield of Texas agreement with reasonable and updated contract terms to help its members in Central Texas continue to have access to our unique combination of high-quality care, advanced and affordable,” said Ascension Texas. in a statement to MySA.

Ascension claims “current market conditions and inflationary pressures” are not taken into account in the contractual terms of insurance providers.

“We are negotiating in good faith and are committed to reaching an agreement that will continue to give BCBSTX members access to Ascension’s facilities at a fair price,” BCBSTX said in a statement released to MySA. “We appreciate 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.”

Ascension, a nonprofit organization, had nearly $18 billion in cash reserves, according to a New York Times report on the company’s staff cuts in recent years. BCBSTX, also a nonprofit, had almost $27 billion in invested assets, including about $1.9 billion in cash and cash equivalents, as of Sept. 30, 2021, according to the most recent financial statements on its website .

BCBSTX serves approximately six million Texans and is the primary health care insurance option for approximately 328,000 state employees at any given time, as well as many of their eligible family members. Retired state employees with at least 10 years of service are also eligible for state health benefits.

However, one in 54 Texans, or more than half a million people, are covered by health insurance through the state, according to the Employees Retirement System of Texas.

An ERS representative told MySA that the nationwide organization was currently monitoring the situation, also noting that most of the time such contract disputes are resolved.

If not, Ascension hospitals would no longer be covered by the Blue Choice PPO, Blue Essentials, Blue Advantage HMO and Medicare Advantage PPO networks as of Feb. 1. A coverage termination notice was also sent to Ascension by BCBSTX for physicians and other health care professionals employed by the medical group.

“If we do not reach a reasonable agreement, physicians will leave the Blue Choice PPO, Blue Essentials and Medicare Advantage PPO networks on May 1,” BCBSTX said in a statement. “Physicians and health care professionals will also leave the Blue Advantage HMO network on June 15.”

However, Ascension hospitals will remain in the Medicare Advantage HMO and Medicaid networks. Additionally, BCBSTX-covered persons receiving treatment from Ascension for a pregnancy, disability, acute condition, or life-threatening illness may qualify for in-network rates as continuing care patients.

Both organizations are encouraging those covered by BCBSTX to call the customer service number on their ID card, either to find a new provider or to express support concerns for either company.

MySA’s Chris O’Connell contributed reporting to this story.