Two days ahead of a contract deadline that threatens thousands of North Texas residents’ in-network health coverage at Medical City Healthcare facilities — the state’s largest insurer Blue Cross Blue Shield of Texas and the hospital chain I have a deal is imminent.
The negotiations come as patients across Texas received notification that in-network coverage between the state’s largest health insurance provider and one of the region’s largest hospital chains might come to an end on April 1. Despite the warnings, the two sides said they expect a deal so patients don’t lose access to doctors or are at risk for out-of-network fees.
The proposed one-year contract agreement means patients likely won’t need to switch doctors and facilities at the end of the month.
“This new contract will reflect our mutual commitment to quality, affordable health care,” said Jim Springfield, president of BCBSTX. “As a customer-owned health insurance industry leader in Texas for more than 90 years, we must protect our members’ access to care at fair rates.”
Medical City is a branch of HCA Healthcare, a Nashville, Tenn.-based, for-profit health care operator that runs facilities across 21 states. In North Texas, the provider runs 16 hospitals, 13 ambulatory surgery centers, five off-campus emergency rooms and the CareNow Urgent Care network.
On Wednesday, a Medical City spokesperson said the provider continued to have “very productive” discussions with BCBSTX.
“Medical City Healthcare is committed to reaching a fair agreement by April 1 so that BCBS members continue to have access to the convenient and quality healthcare they expect in North Texas,” Medical City said in a statement.
It’s not uncommon for insurers and providers to clash over reimbursement rates and contract lengths. It’s also not the first time Medical City and Blue Cross have been at odds. In 2016 and 2019, the two were unable to make progress on settling disputes about care costs.
“Medical City continues to demand unreasonably high rate increases that would burden our members with additional, unnecessary costs with no guarantee of better health outcomes,” stated Blue Cross Blue Shield in a 2019 press release. “This is unwarranted and unacceptable.”
Contract negotiations between the insurer and the provider were amicable this time around, especially in comparison to the contentious bargaining between BCBSTX and UT Southwestern Medical Center, said a BCBSTX spokesperson. The October standstill almost jeopardized nearly half a million North Texas patients’ in-network coverage, as negotiations ran through the night and into deadline day.
Often the public isn’t made aware of an insurer’s and provider’s disputes. That is, unless it’s 30 days ahead of a contract deadline and an agreement hasn’t been reached. Then the insurer is typically obliged to notify members utilizing a provider’s facilities of the bartering.
BCBSTX sent out postcards to some members and created a website about the ongoing negotiation.
Regardless of the outcome of a contract negotiation, certain patients, like those being treated for life-threatening illnesses or pregnancy, can have continuity-of-care benefits. That means that they may still be able to see their doctor, even if the medical facilities are no longer in-network due to a failure to reach an agreement.