By Andy Sevilla.
The Central Texas Medical Center no longer is in BlueCross BlueShield’s network of healthcare providers after several months of contractual negotiations fizzled, impacting thousands of Hays County residents covered by the private health insurer.
CTMC, an Adventist Health System Hospital, claimed BlueCross BlueShield (BCBS) had a history of underpaying the hospital for services. The hospital also alleged in a statement that BCBS refused CTMC’s offer to bring in a third-party auditor to confirm the proposed rates offered for service in a new contract were in-line with what the private insurer pays other hospitals.
BCBS, however, accused CTMC of requesting a “significant increase” in reimbursement rates for the same services provided under its now-expired contract. BCBS officials said in a statement they offered Adventist a “reasonable” cost increase in line with what they pay other hospital systems.
BCBS officials said they’re disappointed with the outcome, but their “priority now is to transition our members to other quality, experienced and credentialed hospitals serving our members in the greater Central Texas area.”
CTMC spokesperson Clay DeStefano said the circumstance is not unusual or atypical during negotiations.
“It happens every couple of years,” he said in a telephone interview Friday.
The hospital, DeStefano said, remains committed to reaching an agreement with the private insurer.
President and CEO of CTMC Sam Huenergardt said in a statement, “this is certainly not the outcome we wanted, but we remain fully committed to working with our patients to continue providing the care they need through their local, community hospital. We are working diligently to help (BCBS) members understand their options and ensure a smooth transition.”
CTMC officials, however, still worry clients may seek healthcare elsewhere as BCBS member costs will increase for certain services, DeStefano said.
Seton Medical Center Hays spokesperson Steve Taylor said Seton and its clinics in Hays County are in the BCBS network. He said Seton welcomes clients impacted by CTMC and the insurer’s current situation, and further welcomed those affected to learn about the medical services provided at Seton Hays.
“We are prepared for and welcome any influx of new patients,” Taylor said.
And a potential BCBS client exodus to Seton Hays and other in-network hospitals is what the private insurer subtly hinted at in its statement announcing the April 7 dissolution of their relationship with CTMC.
DeStefano, on the other hand, encouraged BCBS members of CTMC to fight for healthcare coverage at the hospital they have come to trust.
He said the insurer and CTMC will come to a resolution, but for now, insurer members should contact BCBS and say they want to stay at CTMC and to tell the insurer they “have that right.”
