DALLAS – There are some uneasy, expecting moms across North Texas this week.
Blue Cross Blue Shield of Texas – the largest insurance provider in the state – is in a contract dispute with Texas Health Resources – a major health care provider.
If they don't reach a deal, that could mean your doctor will be out of network starting next month. That includes mothers who seek out Texas Health Presbyterian Hospital as a premier place to have their babies, and a landmark for new moms in North Dallas.
It’s where Robyn Robertson is planning to have her third child in February.
Robertson has blue cross blue shield insurance and her doctor is in her network at Texas Health Presbyterian hospital which is operated by Texas Health Resources.
She first heard about the contract dispute after reading a news report online. She called her doctor’s office first thing Tuesday morning in a panic.
"I thought surely this can't be correct,” said Robyn Robertson, an accounting professor at Richland College. “This is obviously a really big deal."
Robertson said she was advised to either change insurance or change doctors.
“Neither of those are a good option right now,” she said. “I’m really just worried, and I really want this to be resolved.”
According to Blue Cross and Blue Shield, there are Continuity of Care provisions written in most health plans that provide relief for individuals in situations similar to Robertson. Other health care situations are likewise covered under this provision.
Although contract disputes are common between insurers and providers, Dallas health economist Devon Herrick said a potential break could be really hard on patients and their families.
“Consumers are the ones who will pay the price for either higher premiums or lower access to the doctors and hospitals they've been using in the past,” Herrick said.
In a statement to News Channel 8, Texas Health Resources CEO Barclay Berdan said the company did not want to discuss negotiations in public, adding in part, “Their (BCBS) continued delays place patients, their employers and their physicians in the middle of this and may ultimately and significantly disrupt care.”
Texas Health Resources serves more than 7 million people in North Texas. It asked to extend its contract with a 4-percent increase from Blue Cross Blue Shield.
However, the health insurer was offering a 2-percent increase. It’s a difference that Blue Cross Blue Shield said could potentially cost them $57-million, an increase that is “unacceptable,” BCBSTX spokesman Gustavo A. Bujanda said in a statement to News Channel 8. The statement also said in part that, “Texas Health rejected our proposed extension and countered by proposing new short-term contracts with egregious rate increases that would cause our members to bear the burden of additional unnecessary and unwarranted costs with no guarantee of better health outcomes.”
If the two cannot reach an agreement by December 31, people like Robyn Robertson will find themselves with some tough decisions to make: pay more or change.
"I'm really disappointed that one of the largest insurers and one of the largest providers can't come to an agreement,” Robertson said. "I don’t know what to do.”
Full statement from Barclay Berdan, CEO Texas Health Resources:
Since May we have been waiting for BCBSTX to engage in negotiations with Southwestern Health Resources, the highly integrated network that combines the strengths of Texas Health and UT Southwestern.
Blue Cross has waited to substantively engage until deep into the open enrollment period knowing that Texas Health’s contract expires on Dec. 31, 2016.
Blue Cross finally put an offer on the table for a two percent increase, then rescinded it today. We had offered to extend this contract with a modest four percent increase.
While our actual costs are increasing at a rate of more than four percent, we were, and remain, willing to accept a reasonable increase. The goal of this extension is for Southwestern Health Resources and BCBSTX to have time to negotiate a contract that is in the best interests of all parties, most importantly patients, physicians and employers. Had BCBSTX engaged when approached by Southwestern Health Resources, it is unlikely that the need for any extension of the existing THR contract would have been necessary.
Southwestern Health’s integration represents everything North Texans and the region’s employers want from the health care system – enhanced quality, affordability, improved care coordination, and a comprehensive network of high-quality physicians and services.
It’s also what health plans around the country have been demanding from providers, and reflects a shift in how health care delivery is being transformed across the country.
Ultimately, Southwestern Health Resources will help Texas Health and payers, such as Blue Cross, to better control the overall total cost of care.
We have repeatedly pointed out to BCBSTX that we do not want to negotiate this contract renewal in public. Their continued delays place patients, their employers and their physicians in the middle of this and may ultimately and significantly disrupt their care. This need not have happened.
Texas Health provides in excess of one billion dollars in services to BCBSTX members each year. Any figures BCBSTX uses is an effort to grab headlines, and should be taken with a truckload of salt.
We remain committed to reaching an agreement with BCBSTX before the end of the year regarding an extension so that we can continue providing the high-quality, compassionate care for which we are well known. This we believe would be in the best interests of patients, physicians and the community.
The overall costs of delivering health care continue to escalate at a tremendous and unsustainable pace. While we value our relationship with Texas Health, in aggregate, THR is currently the most expensive health care provider in North Texas. The proposed rate increases would result in approximately $57 million in additional costs for our members. As stewards of our members’ health care dollars, this is unacceptable.
BCBSTX offered Texas Health an opportunity to extend their current contracts for one year to allow additional time to negotiate longer-term contracts. Texas Health rejected our proposed extension and countered by proposing new short-term contracts with egregious rate increases that would cause our members to bear the burden of additional unnecessary and unwarranted costs with no guarantee of better health outcomes.
The contracts between Blue Cross and Blue Shield of Texas (BCBSTX) and both Texas Health Resources (THR) and Texas Health Physicians Group (THPG) will expire on Dec. 31, 2016. Unless all of the parties reach agreement on extensions to the current contracts, THR and THPG will no longer be part of BCBSTX’s networks as of Jan. 1, 2017.
BCBSTX has been and will continue to work toward an agreement with Texas Health.Note: Story updated with explanation of continuation of care and full statement from Blue Cross Blue Shield.