If you are a Blue Cross and Blue Shield of Texas member, you may soon lose access to the largest nonprofit health care system in the state.
The Richardson-based health insurer is undergoing contract negotiations with Dallas-based Baylor Scott & White Health as the two companies remain in a dispute over reimbursement rates.
A spokesperson with Blue Cross and Blue Shield said the health insurer was notified that Baylor Scott & White will terminate its contract “unless we significantly increase what we pay them.”
Patients were notified through mail and emails that the two companies are working to reach an agreement by July 1.
Matthew Olivolo, a spokesperson for Baylor Scott & White Health, said the system’s patients are its priority and it is “continuing to negotiate in good faith to prevent any disruption.”
What would a contract termination mean for Tarrant County residents?
Blue Cross and Blue Shield serves nearly 8 million people across Texas. The health insurer is the largest in Texas and nearly double the size of the next-largest health insurance company, UnitedHealthcare, which serves more than 4.7 million across the state.
In early 2020, United Healthcare faced similar contract disputes with Houston Methodist. The two companies ended their in-network contract for nearly five months until a new contract was approved in May of that year, according to Dallas Morning News.
Baylor Scott & White operates more than 50 hospitals and 800 patient care sites, and has over 7,000 physicians in its network. The health system reported over $1.22 billion in revenue in 2022.
If an agreement is not reached, Blue Cross and Blue Shield members will have to pay out of pocket or higher rates for Baylor Scott & White doctors and facilities. This includes the health system’s hospitals, clinics, ambulatory surgery centers, imaging centers, surgery centers and urgent care facilities.
Baylor Scott & White did not disclose how many of its Tarrant County patients have coverage through Blue Cross and Blue Shield.
Which Blue Cross and Blue Shield plans are included in the negotiation?
- ParPlan
- Health Select
- Blue Choice PPO
- Blue Essentials
- Blue Advantage HMO
- Blue Premier/High Performance Networks
- Blue Cross Medicare Advantage (PPO)
- Blue Cross Medicare Advantage (HMO)
- Managed Medicaid STAR Kids
Those Blue Cross and Blue Shield members who want to continue receiving care from a Baylor Scott & White provider would see an increased cost in care, according to the health system’s website.
Patients who are already hospitalized or undergoing treatment before July 1 may still qualify for coverage. Patients who are being treated for an acute condition, disability or life-threatening illness may qualify for Continuity of Care benefits through Blue Cross and Blue Shield.
Those eligible people must apply by filing a Continuity of Care form on the health insurer’s website as soon as possible. Patients can also call the number on the back of their insurance card to request a form. Since Blue Cross and Blue Shield approves and denies requests, Baylor Scott & White cannot provide status updates.
The dispute over reimbursement rates remains an industrywide issue, as growing labor and supply costs put financial strains on health care facilities.
Several Tarrant County health facilities have closed their doors in 2024, with insufficient funding remaining an underlying, unresolved problem, Ethan Garner, managing director and region lead with Healthcare & Life Sciences Brokerage at JLL, previously told the Report.
“Inflationary pressures and tighter spending further exacerbate the situation, making it increasingly difficult to address these systemic issues,” he said.
While other businesses and industries can raise prices when labor costs increase, the same does not apply in health care. Providers who rely on insurance payments can only increase prices during contract negotiations with payers when they decide on reimbursement rates.
Dr. Jeff Beeson, interim executive vice president for health systems at the University of North Texas Health Science Center, previously told the Report the reimbursement model in the U.S. is an issue for care providers.
Between today and July 1, there will be no disruptions to anyone’s in-network coverage, a Baylor Scott & White spokesperson said in an email.
Baylor Scott & White advises patients to keep appointments they have scheduled on or after July 1, as canceling services could “delay care and it may not be necessary if an agreement is reached before the current contract expires.”
David Moreno is the health reporter for the Fort Worth Report. His position is supported by a grant from Texas Health Resources. Contact him at david.moreno@fortworthreport.org or @davidmreports.
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