If you’re a Blue Cross Blue Shield of Texas member, you could soon lose access to the state’s largest nonprofit health care system.
The Richardson-based health insurer is in contract negotiations with Dallas-based Baylor Scott & White Health, but the two companies are still battling over reimbursement rates.
A Blue Cross Blue Shield spokesman said the company had notified Baylor Scott & White it would terminate its contract “unless it significantly increases payments.”
Patients were notified by mail and email that the two companies were working to reach an agreement by July 1.
Baylor Scott & White Health spokesman Matthew Olivolo said the system’s patients come first and that the company is “continuing to negotiate in good faith to avoid any disruptions.”
What does the termination of the contract mean for Tarrant County residents?
Blue Cross & Blue Shield serves approximately 8 million people across Texas. The company is the largest health insurer in Texas and is nearly twice the size of the second-largest health insurer, UnitedHealthcare, which serves more than 4.7 million people statewide.
UnitedHealthcare faced a similar contract dispute with Houston Methodist in early 2020. The two companies terminated their in-network agreement for about five months before a new contract was approved in May of that year, according to the Dallas Morning News.
Baylor Scott & White operates more than 50 hospitals and 800 patient care sites with more than 7,000 physicians in its network. The health system reported revenue of more than $1.22 billion in 2022.
If no agreement is reached, Blue Cross Blue Shield members will have to pay out-of-pocket or higher fees for Baylor Scott & White doctors and facilities, which include the health system’s hospitals, clinics, outpatient surgery centers, imaging centers, surgery centers and urgent care facilities.
Baylor Scott & White would not say how many of its Tarrant County patients are insured through Blue Cross & Blue Shield.
Which Blue Cross and Blue Shield plans are included in the negotiations?
- Par Plan
- Health Select
- Blue Choice PPO
- Blue Essential
- Blue Advantage HMO
- Blue Premier/High Performance Network
- Blue Cross Medicare Advantage (PPO)
- Blue Cross Medicare Advantage (HMO)
- Managed Medicaid STAR Kids
Blue Cross & Blue Shield members who want to continue receiving care from Baylor Scott & White providers will see an increase in their medical costs, according to the health system’s website.
Patients who were already hospitalized or treated before July 1 may continue to be eligible for coverage. Patients who are being treated for an acute illness, disability or life-threatening disease may be eligible for continuing care benefits through Blue Cross and Blue Shield.
Those who are eligible should apply as soon as possible by submitting a Continuing of Care form on their health insurer’s website. Patients can also request a form by calling the number on the back of their insurance card. Because Blue Cross and Blue Shield approves and denies requests, Baylor Scott & White cannot provide status updates.
Controversy over reimbursement rates remains an industry-wide issue as rising labor and supply costs place financial strain on healthcare facilities.
Ethan Garner, managing director and regional leader of JLL’s healthcare and life sciences brokerage practice, previously told the report that several medical facilities in Tarrant County are set to close in 2024, leaving a lack of funding as a fundamental unresolved issue.
“Inflationary pressures and spending cuts are making the situation even worse, making it increasingly difficult to address these systemic issues,” he said.
While other businesses and industries can raise prices when labor costs rise, the same is not true in health care: Health care providers who rely on insurance payments can only raise prices when they negotiate contracts with payers to determine reimbursement rates.
Dr. Jeff Beason, interim vice chancellor for health system affairs at the University of North Texas Health Science Center, previously told the report that the U.S. reimbursement model is problematic for health care providers.
A Baylor Scott & White spokesperson said in an email that there will be no interruptions to coverage for anyone in its network between now and July 1.
Baylor Scott & White Hospital is advising patients to keep any appointments scheduled after July 1 because canceling services “may result in delays in care that may no longer be needed if an agreement is reached before the expiration of current contracts.”
David Moreno is a health reporter for the Fort Worth Report. His position is supported by a grant from Texas Health Resources. He can be reached at david.moreno@fortworthreport.org or David Report.
At Fort Worth Report, news decisions are made independently of our board of directors and financial backers. Read more about our editorial independence policy here. here.
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