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Blue Cross Blue Shield could remove Ascension Texas hospitals from its network

Both groups have until Jan. 31 to come to terms.

AUSTIN, Texas — Editor's note: Ascension Texas says it has reached an agreement with Blue Cross Blue Shield as of Jan. 26.

Ascension Texas hospitals and Blue Cross Blue Shield (BCBS) are in contract negotiations that, if left unresolved, could result in the insurance company dropping Ascension from its in-network coverage.

A spokesperson for Ascension confirmed the news with KVUE on Friday, providing the following statement:

"Ascension Texas is committed to building healthy communities and providing access to quality, affordable healthcare services for all those we are privileged to serve.

"We are seeking to renew our Blue Cross Blue Shield of Texas (BCBSTX) agreement with reasonable and updated contract terms to help ensure its members in Central Texas can continue to access our unique combination of high-quality, advanced and affordable care. 

"Ascension Texas is continuing to work with Blue Cross Blue Shield of Texas on contract terms that will ensure BCBSTX policyholders maintain in-network access to Ascension Texas hospitals, physicians and hospital-based clinics including Dell Children’s Medical Center, and select joint venture facilities, including Ambulatory Surgery Centers. Without a commitment to reasonable terms, our current agreement with BCBSTX will end on January 31, 2023 for BCBSTX’s Commercial and Medicare Advantage members. Impacted patients can visit healthcare.ascension.org/BCBSTX or call 833-620-0183 for additional information. We encourage all patients to call the number on the back of their Blue Cross Blue Shield insurance card for details on impact to coverage, available physicians or sites of care before receiving care and to express concerns."

In short, if both groups do not come to terms by the end of the month, their contact will end and BCBS patients formerly in network will need to seek out alternative providers for covered care.

"We are negotiating in good faith and committed to reaching an agreement that will continue to give BCBSTX members access to Ascension facilities at a fair price," BCBS said, in part, in a statement earlier this week. "We value the care Ascension provides our members, but it is already one of the most expensive health systems in the Austin and Central Texas area. As a customer-owned health insurance industry leader in Texas for more than 90 years, it is important to stand up for affordable care, especially in a time when most businesses and our members in the Austin and Central Texas region are facing inflationary pressures and a potential recession."

BCBS noted that without a new agreement, Ascension hospitals will leave the Blue Choice PPO, Blue Essentials, Blue Advantage HMO and Medicare Advantage (PPO) networks on Feb. 1, however, hospitals will remain in the Medicare Advantage (HMO) and Medicaid networks.  

"To protect our members, we submitted a termination notice to Ascension for the doctors and health care professionals employed by Ascension," the BCBS statement continued. "If we can’t reach a reasonable agreement, the doctors will leave the Blue Choice PPO, Blue Essentials and Medicare Advantage (PPO) networks on May 1. The doctors and health care professionals will also leave the Blue Advantage HMO network on June 15."

Candace Wenham, MS, BCPA, is a patient advocate with AdvocateATX. She said this dispute falls on the backs of patients.

"The fact that both of these huge, money-making titans are fighting over prices that are ultimately highly inflated charges on the hospital’s chargemaster is ridiculous," said Wenham. "Both companies made profits in the billions last year, with CEO payouts in the millions. We healthcare consumers are funding them."

She said patents should voice their concerns by calling or writing to BCBS.

"Appeal until all appeals are final. Ask for gap exclusions in your policy. If needed, hire someone to appeal for you," said Wenham.

She added that the human resources department through a patient's employer is also a good source for advice and assistance.

"Many times, self-insured employers can override exclusions in coverage or help with out-of-network benefits and get you covered in-network," she said.

Ascension noted that patients can apply for "continuing care" if they are mid-treatment, and those who go to Ascension with trauma can still be treated with BCBS coverage regardless.

BCBS added that other eligible factors for continued care could include pregnancy, disability, acute conditions or life threatening illnesses.

"Be a proactive healthcare consumer prior to going to a hospital in a non-emergency," said Wenham. "Check coverage with your health insurance first, and remember that non-emergent hospitalizations might be out-of-network, especially if one has BCBS and is attempting to utilize an Ascension hospital. If that’s the case, use a different hospital (if one is nearby). If not, you have a good case for an exception by BCBS and can appeal using your right to getting care within a particular mileage near you. If you have a choice, go in-network, but if you cannot, you have rights as a healthcare consumer with BCBS."

BCBS will be posting more information on their negotiations online here.

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