The Ascension Texas Hospital System said it had reached agreements with insurers Blue Cross and Blue Shield of Texas days before the contract expired on February 1.
Blue Cross and Blue Shield of Texas say they are finalizing details but are close to an agreement. Neither side shared details of the length of the contract.
In a statement, the hospital system said, “We are pleased that our patients, who are members of our (Blue Cross and Blue Shield of Texas), will continue to have access to world-class care and the high quality and advanced services available only at Ascension Texas. I will.” statement. “Central Texas’ population is growing, and so is its healthcare needs. The new agreement will allow the community to continue to access quality care with Ascension’s renowned and trusted providers. Patient is still able to make appointments with providers. Normal.”
Here’s what we know about contractual agreements:
What would have happened if no agreement had been reached?
Absent a new contract, after February 1, people with Blue Cross and Blue Shield of Texas policies will pay out-of-network charges, not in-network charges, when receiving care at an Ascension Texas hospital. would have had to pay for This can lead to thousands of dollars in out-of-pocket costs, including differences in deductibles and maximum co-payments.
Understanding the problem:Blue Cross and Blue Shield may remove Texas Ascension hospital from network
How many people may have been affected?
The Blue Cross and Blue Shield of Texas is the state’s largest private health plan, 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, Teacher Retirement System in Texas.
About 66,000 people with Texas Blue Cross and Blue Shield health plans used Ascension Texas hospitals last year, according to insurance companies.
Ascension Texas 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 Batrop, Ascension Seton Smithville, Ascension Seton Highland Lakes in Burnet, Ascension Each hospital in Seton is included. Edgar B. Davis of Luling and Ascension Providence of Waco. Many of these hospitals also have clinics affected by the contract.
Other Ascension News:Central Health and Ascension Seton suing each other in ongoing contract dispute
What are the next steps for people with Blue Cross and Blue Shield insurance?
All Ascension Texas hospitals will remain within the network of Blue Cross and Blue Shield of Texas members. For those who have this insurance, there will be no change on February 1st. The amount paid by the employee was not part of this contract. Blue Cross and Blue Shield of Texas negotiate independently with insurers and employees’ workplaces how consumers pay for insurance and services.
Was this contract dispute unusual?
No. Insurance companies negotiate with health care providers, including all hospital systems, every few years. The difference in this case is that Ascension Texas published their disagreements by sending letters to those who had Blue Cross and Blue Shield of Texas plans and used the services of the hospital system. The letter said that after February 1st, out-of-network charges would have to be paid if no agreement was reached. The letter also encourages subscribers to call Blue Cross and Blue Shield of Texas to verify coverage.
This raised concerns among Blue Cross and Blue Shield customers, especially parents with children who used Dell Children’s Medical Center for specialized services not available at other local hospitals.
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What was the contract dispute?
Money was at the root of the dispute, mostly related to Ascension Texas getting reimbursed from Blue Cross and Blue Shield of Texas. Both are big money companies.
Ascension Texas’ 11 hospitals had operating income of $399.6 million in 2021, according to the National Academy of Health Policy Hospital Expenses and Resources. Owned Health Care Service Corporation Group had 2020 net income of $3,889 million.
Shara McClure, vice president of healthcare delivery for Blue Cross and Blue Shield of Texas, said earlier this month that the dispute involves millions of dollars.
Blue Cross and Blue Shield of Texas said they offered increased cost coverage, but “so far their demands have exceeded our willingness to pay,” McClure said. She said that compared to two other hospital systems in the area—St. Children’s) is one of them, the highest in the state.”
The hospital system and insurance companies were also fighting over contract language that McClure said prevented insurance companies from conducting claims reviews to ensure proper bill changes.
Blue Cross and Blue Shield of Texas have also said they cannot offer plans that exclude Ascension hospitals.
“We want to be able to maintain our sovereignty,” McClure said.
