Area residents who rely on Texas Health Resources and Blue Cross Blue Shield of Texas are asking if the two companies will reach an agreement before the New Year.
According to Christopher Leu, president of Texas Health Harris Methodist Hospital Stephenville, the current contract between the healthcare provider and insurance carrier expires on Dec. 31, and the companies have been working to reach a new agreement since July.
According to an informational website created by Texas Health Resources (THR), www.texashealth.org/bcbsquestions, if a deal is not reached, Texans insured by Blue Cross Blue Shield (BCBSTX) could lose access to the 24 hospitals and 18 outpatient facilities operated by THR as well as the 5,500 physicians who refer patients to THR hospitals.
As negotiations continue, patients who have recently turned to the Stephenville hospital for medical services have been shocked by information they received during the visit which projected the out-of-pocket costs they could incur if a new agreement is not signed.
Leu said Monday that THR has been working over the last several weeks to keep affected patients, physicians, hospital leadership and BCBS subscribers informed on the ongoing negotiations.
According to the THR website, which addresses a number of questions raised by BCBSTX clients, patients scheduled for a procedure after Dec. 31 could see increased costs if an agreement is not met.
"You can still have your procedure done at our hospitals, but you will be considered out-of-network," the website states, adding that it's best to call the telephone number on the back of your insurance card for questions relating to specific services.
The website also states that after Dec. 31, PPO members with out-of-network benefits can still access care at THR hospitals, with greater out-of-pocket costs; HMO members will only have access to THR through its emergency departments for emergency care; and patients in an active course of treatment for an acute medical condition or a chronic condition may qualify for continuity of care with the Texas Health providers.
"Patients can always access emergency care through our emergency department, regardless of the outcome of our negotiations," THR states.
In the meantime, THR states that BCBSTX clients needing care through Dec. 31 are covered.
"For the rest of 2010, you can still access care with Texas Health hospitals and physicians in the same way you have in the past," the THR website states. "However, if an agreement isn't reached by Dec. 31, your access to Texas Health providers will be restricted and you will have to pay more money out-of-pocket if you choose to receive care with us after that date."
But the only question on patients' minds as the contract expiration date draws near is a simple one - will the contract between THR and BCBS end?
"We remain hopeful that we will be able to reach an agreement that will allow our hospitals and physicians to stay in the BCBSTX provider network and not disrupt care for the communities we serve," THR states. "We remain committed to reaching an agreement, but we need BCBSTX to recognize the value of the care our hospitals and physicians provide and acknowledge the increases in the cost of doing business."
What has changed since the last negotiation?
According to THR, the cost of doing business is the reason negotiations have not yet led to an agreement.
"Since our last contract, our expenses have increased just like every other business. We are only asking that our new contract with BCBSTX be structured to cover these increases, so we can keep our network intact and provide our patients with convenient access to care close to home," THR states. "This small increase is essential to providing quality care now and in the future by maintaining and investing in our physicians, facilities and new services and treatments."
Leu said he remains confident as THR continues to work to reach a resolution that will serve the needs of all stake holders.
"We are very hopeful that an acceptable agreement will be reached by January 1," Leu said, adding that THR is calling on patients insured by BCBSTX to share concerns with the insurance carrier to help facilitate an agreement.