Blue Cross Blue Shield of Texas consumers can expect to pay more out of their own pockets for some treatment after negotiations between Northwest Texas Hospital and the region’s largest insurer failed.
As of Saturday, at the start of the new year, Blue Cross patients are now being charged out-of-network prices at Northwest, which means people needing specialized treatment – like trauma and wound care and some pediatric services that only Northwest provides – could potentially see costs increase by tens of thousands of dollars depending on the treatment.
Northwest houses the region’s largest designated trauma center.
John Greeley, a spokesman for the Texas Department of Insurance, said in most cases when someone goes out of network, it means that the amount of coverage from the insurer drops and the percentage of the bill the patient is responsible for rises.
According to the Texas Department of Insurance’s 2010 annual report, in 2009 Blue Cross was by far the state’s largest accident and health insurer. In 2009, Blue Cross Texans held about 27.3 percent of the market share for written premiums, according to the state.
Blue Cross spokeswoman Margaret Jarvis said Blue Cross will still pay in-network treatment costs, but the patient will cover the co-pay and whatever the difference is between what the insurer covers and the final hospital bill.
Jarvis said she wouldn’t speculate on the cost impact for consumers, but Northwest officials have previously said the patients’ out-of-pocket expenses could top tens of thousands of dollars on a trauma bill.
Starting in 2005, the hospital charged Blue Cross in-network prices – or essentially a discounted rate – for specialized services. But in September, hospital officials announced they canceled the contract with the insurer because Northwest was not a full network provider. Hospital officials said it didn’t make sense for them to offer Blue Cross a discount for specialized services when the insurer was directing patients with all other medical needs to Baptist St. Anthony’s Health System for treatment.
Both sides initially said they hoped talks could resolve the dispute before it affected patients’ pocketbooks, but negotiations ultimately failed.
Martin said the hospital “hates this (outcome) as much as everybody,” but still has to do business.
“We were the ones that canceled our contract,” said Northwest spokeswoman Caytie Martin. “They have refused to accept our calls to have any further conversations. Blue Cross is not willing to allow us to (be) a fully in-network facility.”
Jarvis said she doesn’t expect a big effect for consumers because they can get all their emergency care needs – minus trauma care – at BSA.
She said it’s up to Northwest how much extra the patient will have to pay.
“It’s up to them if they choose to balance-bill a patient and charge them over and above the rate that their insurance pays,” she said.
Martin said no contract means no discount for Blue Cross patients.
“We hope those that may be impacted by that decision have the ability to speak with their employers about their concerns that they don’t have trauma coverage,” she said.
Ultimately, Greeley said the state has little oversight on the relationship between insurers and hospitals other than to make sure insurers provide enough in-network specialists.
“We can’t change the fact that a particular facility and a particular insurer have parted ways,” Greeley said. “We can’t make that better.”
Greeley said the state offers a consumer hot line to help people understand their insurance bills and responsibilities.
“At some point they’re going to get a bill and they’re going to have questions about it,” he said. “(We can help) make sure it is according to the contract they have and answer any other questions.”