66,000 could lose access to this Austin hospital network at the end of the month. Is your coverage changing?

AUSTIN (KXAN) — Blue Cross Blue Shield of Texas says 66,000 of its insured patients received care at Ascension hospitals and surgery centers in the last year – ongoing contract negotiations between the companies could end access to those healthcare facilities if there is no agreement.

A statement from Ascension Texas to KXAN said the current agreement with Blue Cross Blue Shield of Texas will end at the end of January.

This would make more than 50 hospitals, centers, and surgery centers out of network for patients in and around Austin, as well as Waco. Dell Children’s Medical Center among them.

We reached out to the hospital system after several policy holders messaged us at ReportIt@KXAN.com.

The statement read in part: “Without a commitment to reasonable terms, our current agreement with BCBSTX will end on January 31, 2023 for BCBSTX’s Commercial and Medicare Advantage members.”

KXAN also received a statement from Blue Cross Blue Shield of Texas that said this change would impact more than 60,000 patients – starting first with the exclusion of Ascension hospitals on February first, eventually coming to exclude doctors and health care staff by mid-summer.

The statement read in part: “To protect our members, we submitted a termination notice to Ascension for the doctors and health care professionals employed by Ascension. If we can’t reach a reasonable agreement, the doctors will leave the Blue Choice PPO, Blue Essentials and Medicare Advantage (PPO) networks on May 1. The doctors and health care professionals will also leave the Blue Advantage HMO network on June 15. “

Both companies encourage members to check their coverage using the policy information on their member ID cards.

‘I feel like a pawn’: patients caught up in contract battle

Claire Tapscott is excited to be a new mom. Her birth plan includes delivering her baby girl at Ascension Seton hospital, but an email from the healthcare system on Monday sent her into a panic. Her plan was in trouble.

“I just went into panic mode, trying to figure out, Is my doctor going to be covered? Are the hospitals going to be covered?,” said Tapscott.

After calls to BCBSTX, she learned her hospital of choice as of February 1 would no longer be covered by her insurance without the companies agreeing to a partnership.

Her OBGYN would still be covered, but Tapscott says she was unsure if she had hospital privileges at any other area hospitals.

This gave her two options: stick with her doctor at the risk of paying out-of-network prices at another hospital, if he even had privileges there – or find a new OBGYN, healthcare team, and hospital one month from her due date.

“I’m 34 weeks pregnant. And I love my doctor, I don’t want to find a new doctor. I feel like a pawn, I feel like patients are pawns in this conversation,” said Tapscott.

BCBSTX is taking applications for ‘continuity of care’ – this grants members being treated for pregnancy, disability, acute condition, or life threatening illnesses to receive in-network rates at Ascension facilities if it leaves its network.

The insurance company asks members to check their eligibility by calling the number on their member ID card.

Although doctors and healthcare professionals won’t be taken out of network until May 1 and again on June 15 – dad of three Michael Wilson says he’s worried.

One of his children has a chronic condition which requires regular specialist visits. He says this change would take his child away from the doctor who is already familiar with their needs and treatment.

“I think as big entities fight it out, it seems like patients are the ones that kind of get squeezed in the middle,” said Wilson.

BCBSTX provided this web page for updates on the ongoing negotiations. Ascension has also provided its own web page.

Ascension and BCBSTX both say they are working to come to an agreement.

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