Blue Cross, Ascension dispute could leave thousands paying out of pocket for care in Austin
An impasse in negotiations between one of the largest insurers in Texas and one of the largest hospital systems in Austin could mean gaps in coverage for thousands of Central Texans.
Blue Cross Blue Shield and Ascension Hospitals are renegotiating rates for health care costs paid by the insurer ahead of a Jan. 31 deadline. Ascension says Blue Cross’s proposal is too low; Blue Cross says Ascension is asking too much.
If a deal isn’t reached by the end of the month, services for Blue Cross customers at nearly 60 hospitals and surgical centers will be considered "out of network" come Feb. 1 and patients will have to pay out of pocket.
An estimated 66,000 Blue Cross customers would be affected, the insurer says. That includes many City of Austin and UT employees. (Disclosure: KUT receives benefits through UT’s Blue Cross plans.)
Blue Cross clients make up a quarter of the insurance market in Texas. Ascension runs Dell Children’s and the Dell Seton Medical Center, along with nearly 60 clinics, surgical centers and other medical facilities in Central Texas.
In statements to KUT, both parties said they were working toward a solution ahead of the deadline.
Blue Cross Blue Shield said it was "negotiating in good faith."
"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," its statement read.
Ascension said, "without a commitment to reasonable terms," the agreement could expire. It urged affected patients to go to its website for more details or to call the number on the back of their Blue Cross Blue Shield cards.
In its notification to customers, Ascension said a contract expiration could mean a "two-to-three hour drive" for Central Texans to receive emergency care at a level 1 trauma facility, the highest standard-of-care rating by the Texas Department of State Health Services.
Dell Seton and Dell Children's are the only facilities in Central Texas rated level 1 for trauma care.
Blue Cross' policy states, however, that its customers won't have to pay out of pocket for emergency care.
Customers receiving ongoing care — for example, prenatal treatment or radiation — at an Ascension facility also would not be forced to go to another provider because of state and federal laws requiring what's called continuity-of-care.
If a deal isn't reached, primary care and other specialty doctors in Ascension's system will be considered out-of-network starting May 1.