An agreement was reached to keep Ascension part of the Blue Cross/Blue Shield network
The Ascension Hospital System in Texas says it has reached an agreement with insurer Blue Cross and Blue Shield of Texas, just days before their contract expires on Feb. 1.
Blue Cross and Blue Shield of Texas say they are finalizing details but an agreement is imminent. Neither side has shared details about the duration of the contract.
“We are pleased that our (Blue Cross and Blue Shield of Texas) members – our patients – will continue to have access to world-class care and advanced, high-quality services available only through Ascension Texas,” the hospital system said in a written message. statment. “The population of Central Texas is growing and so are the health care needs. The new agreement … ensures that the community can continue to receive quality care with Ascension providers that are known and trusted. Patients can continue to make appointments with their providers as normal.”
Here’s what we know about the contract agreement:
What would have happened if no agreement had been reached?
Without a new contract, starting February 1, people with Texas Blue Cross and Blue Shield insurance were required to pay out-of-network fees instead of in-network fees when they received medical care at Ascension Hospital in Texas. That can add up to thousands of dollars in personal expenses, including differences in deductions and maximum out-of-pocket expenses.
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How many people could be affected?
Blue Cross and Blue Shield of Texas is the largest private health insurance in the state, with more than 6 million members, including state employees, City of Austin employees, and University of Texas employees, as well as many local business employees and people who receive insurance through the teacher retirement system in Texas.
Last year, about 66,000 people with Texas Blue Cross and Blue Shield health insurance used Ascension Hospitals in Texas, according to the insurance company.
Ascension Texas Hospitals includes Dell Seton Medical Center, Ascension Seton, Dell Children’s Medical Center, Ascension Seton Southwest, Ascension Seton Northwest, Ascension Seton Hays, Ascension Seton Williamson, Ascension Seton Bastrop, Ascension Seton Smithville, Ascension Seton Highland Lakes in Burnet, Ascension Seton Edgar B. Davis in Luling, and The Rise of Providence in Waco. Many of these hospitals also have clinics that were affected by the contract.
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What’s next for people with Blue Cross and Blue Shield insurance?
All Ascension Texas hospitals will remain in the network for Blue Cross and Blue Shield of Texas members. People with this insurance will see no change on February 1. Payments by employees were not part of this contract. Blue Cross and Blue Shield of Texas negotiate what consumers pay for insurance and services separately with the insurance company and where employees work.
Was this contract dispute unusual?
No. Insurance companies negotiate every few years with health service providers, including every hospital system. What was different in this case was that Ascension Texas publicly exposed the differences by sending a letter to people who had Blue Cross and Blue Shield of Texas plans and used the services of the hospital system. The letter informed them that from February 1, if no agreement could be reached, they would have to pay out-of-network rates. The letter also advised members to contact Blue Cross and Blue Shield of Texas about their coverage.
This raised concerns among Blue Cross and Blue Shield customers, especially among parents whose children used Dell Children’s Medical Center for specialized services not available at other local hospitals.
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What is the dispute about the contract?
Money was the asset of the fight, primarily related to how well Ascension Texas received in compensation from the Blue Cross and Blue Shield of Texas. These two companies deal in large sums of money.
Eleven hospitals in Ascension, Texas, had an operating profit in 2021 of $399.6 million, according to National Academy of State Health Policy Hospital cost and resources. The healthcare services group of companies, which owns Blue Cross and the Blue Shield of Texas, had net income in 2020 of $3.889 billion, According to Best’s Credit report.
The dispute involves millions of dollars, said Shara McClure, vice president of healthcare delivery at Blue Cross and Blue Shield in Texas.
Blue Cross and Blue Shield of Texas said they offered increased coverage, but “their demands so far are higher than we’re willing to pay,” McClure said. Compared to the two other hospital systems in the area — St. David’s Healthcare and Baylor Scott & White Health — she said, Ascension Seton is “already the highest cost system on the market,” and “the[Dell Children’s]children’s facility is one of the highest in the state.”
The hospital system and the insurance company were also fighting over contract language that McClure said would prevent the insurance company from doing claims reviews to make sure billings had the appropriate changes.
Blue Cross and Blue Shield of Texas said they, too, will not be able to offer plans that exclude Ascension Hospitals.
“We want to be able to maintain sovereignty,” McClure said.