Thousands of Texans could be affected
HAYS COUNTY — As a looming deadline is quickly approaching, thousands of Texans could be affected if an agreement is not reached between a major hospital system and one of the state’s largest insurance providers.
The current contract between Blue Cross Blue Shield of Texas (BCBSTX) and Ascension Texas is set to expire on Jan. 31. 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. Ascension hospitals will remain in the Medicare Advantage (HMO) and Medicaid networks.
Ascension doctors would also be removed from the Blue Choice PPO, Blue Essentials and Medicare Advantage networks on May 1. The doctors and healthcare professionals would leave the Blue Advantage HMO network on June 15.
This leaves many to be concerned about the future of their health needs, including current BCBSTX policyholder Kim Meneses. Her husband is an open heart surgery survivor and during his recovery time, he was instructed by the surgeon to seek care at a Level 2 Trauma Center if he ever had cardiac issues or stroke symptoms.
“Ascension Seton Hays is the only Level 2 Trauma Center in Hays County and surrounding areas,” Meneses said. “We currently live in Seguin so we would have to drive to Hays right now. In the event he would need a Level 2 Trauma Center in the future and Blue Cross and Ascension do not meet an agreement, the nearest Level 2 option would be University Hospital in Northwest San Antonio. We have a long history with [Ascension] Seton Hays Hospital and even though it’s a 50-minute drive from our current home, it is our first choice for specialty hospital care.”
Changing insurance providers could be an option for some, but it’s not for all.
“Unfortunately, I don’t have the option of switching insurance companies, as this insurance is the one I pay for from my job,” said Mando Navarro, Hays County resident. “I’d have no option but to travel to another hospital/clinic for healthcare.”
Hays CISD is currently locked into a contract with BCBSTX for this year — if the district had intended to pull away from the insurance provider, it would have had to notify the company in December.
Dr. Fernando Medina, chief human resources officer at Hays CISD, said that several employees rely on the services Ascension Seton Hays provides.
“Last year, we had an alternative healthcare plan made available to our employees and the reason that it was not successful was that Ascension Seton was not in their network and that was among the biggest feedback we received,” Medina said. “Now that is a potential problem, we know that those same employees will be concerned [if] Ascension Seton is not in the network. We are on standby to see what actually happens because even if they decide it’s not going to be something they can work out, there really is nothing our employees are going to be able to do at this time.”
Tracey Ramsey, director of human resources at Wimberley ISD (WISD), said the district contracts with Teacher Retirement System (TRS) to find health insurance. She explained that TRS negotiates the best price for employees and services.
While the negotiations are unsettling for many, Ramsey explained that this happens often.
“They do this every year; this is not the first time … I’ve seen this happen. I was in healthcare before education, and this is not unusual,” Ramsey said. “With everything costing so much more, they are probably just trying to reach a happy medium so that the people offering services can still stay afloat while offering us a good price.”
Ramsey is confident that if an agreement is not reached between BCBSTX and Ascension, TRS will do its best to find another provider for WISD.
“The only thing that it would probably do is make it inconvenient if we have to drive farther, but I know that TRS will do its best. They are a pretty large organization and they should be able to come up with an agreement,” Ramsey said.
In a Jan. 3 statement, Ascension Texas said that it's committed to building healthy communities and providing access to healthcare services.
“We enable insurance companies like BCBSTX to offer value and choice to its members. By removing Ascension Texas from their network, BCBSTX is significantly reducing the value of its members' insurance coverage,” the statement reads.
The statement continued to say that “Ascension Texas offers the area’s only comprehensive, freestanding pediatric hospital in the region and the only Level 1 Trauma Center for adults in the Austin area” and for many patients, “securing comparable services elsewhere would require a two-to-three-hour drive if BCBSTX does not commit to reasonable terms.”
Ascension’s statement concluded that it wants new terms to be reached as soon as possible to prevent any disruption in services for BCBSTX members.
On Jan. 12, BCBSTX released an updated statement about the continued negotiations with Ascension Texas. The insurance provider pledged its commitment to reaching an agreement that will continue members’ access to Ascension facilities at a fair price.
“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 customerowned 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,” the BCBSTX statement said.
BCBSTX also clarified that emergency or trauma services at any hospital, regardless of an existing contract, are covered at in-network rates for BCBSTX members.
“Members being treated for a pregnancy, disability, acute condition or life-threatening illness may qualify as a continuity-of-care patient,” the statement reads. “This means they may still be able to receive care at in-network rates at Ascension even after it leaves our networks. To find out if they are eligible, members can call the number on their member ID card for more information.”
If Ascension facilities and providers leave networks, BCBSTX “will do everything we can to help members move their care to quality, cost-effective, in-network hospitals and healthcare professionals.”
Members can find innetwork care by:
• Visiting the online Provider Finder at www. bcbstx.com/find-care/
providers-in-yournetwork/ find-a-doctor-orhospital
• Registering for Blue Access for Members at www.bcbstx.com/ member/memberresources/ memberservices
• Calling the Customer Service number on their member ID card Updates about the ongoing negotiation can be found at bcbstx.com/ ascensionseton.
