Austin (KXAN) — 66,000 central Texans are still waiting for the resolution to ongoing contract talks between a major hospital system and one of the state’s biggest insurance providers after finding out they could lose access to nearby facilities. One local insurance consultant said that pressure is usually part of the negotiation process.
Last week, Ascension patients insured with Blue Cross and Blue Shield of Texas (BCBSTX) reported receiving messages that they could lose in-network care to the hospital system if companies fail to make an agreement by the end of this month.
Ron Nemetz is an insurance broker of 15 years based in Buda, helping individuals and small companies navigate the health insurance market.
He says his office received several calls and emails related to the dispute between the health juggernauts.
Nemetz says moves like notifying patients about potential coverage changes so close to the agreement deadline is fairly typical during the negotiation process.
He said by sounding the alarm, more pressure is put on the companies to make a deal.
“Because they’ll get the calls from their group carriers, they’ll get the calls from their individual consumers wondering about that. And I think that creates some pressure to negotiation window,” said Nemetz.
Nemetz said this process can cause patients to panic despite most agreements coming together last minute. While expected, he said this can feel unfair to policyholders caught in the middle.
“If you’re going to a particular oncologist, or your child’s getting treatment at Dell Seton for a particular rare condition, I think it’s kind of unfair for those contracts to change mid-year,” said Nemetz.
New statement from Blue Cross and Blue Shield of Texas
BCBSTX did issue an updated statement on its dealings with Ascension.
In summary, the provider says it is still working in good faith to come to an agreement but alleges the health system of trying to make up lost profit in other states by raising prices in Texas.
The statement reading in part:
Ascension Seton is part of Ascension, one of the nation’s largest health systems. Ascension is headquartered in St. Louis, and has more than 2,600 sites of care, including 139 hospitals in 19 states. Nationwide, Ascension has reported operating losses of close to $1 billion despite operating revenue increasing $738 million.
While health care operating costs have increased due to inflation and labor shortages, Seton remains profitable in Texas regardless of the larger Ascension portfolio of hospitals. BCBSTX is willing to pay fair rates but our members should not be expected to supplement shortcomings Ascension is having in other states.
During the last two years, Ascension has expanded aggressively. It has purchased multiple specialist groups and ambulatory surgery centers, immediately increasing the costs for patients of those acquired doctors and facilities. Studies show health care consolidation leads to higher prices and does not necessarily lead to higher quality care for our members.
While we will continue to negotiate in good faith, we want to assure BCBSTX members that we’re committed to reaching an agreement that will continue their access to Ascension facilities at a fair price.Blue Cross and Blue Shield of Texas