Is BCBSTX Paying THR Cost Plus 30%?

Texas Health Resources (THR) and BCBSTX  negotiated a new contract last year – . What reimbursement levels were agreed to by both parties on behalf of hundreds of thousand patients? A BCBS memorandum may provide clues.


What exactly is at issue between BCBSTX and THR? Our current contract with THR ends this year, and they came to us with a new contract proposal that would not allow us to keep coverage affordable for our members.

We’ve been negotiating with THR since July to reach a mutually satisfactory agreement. Unfortunately, we haven’t been able to reach common ground, so THR hasn’t agreed to a new contract.

This means they will not be in our network January 1.

What is BCBSTX’s goal in its negotiations with THR?

The bottom line for us is that we have a commitment to our customers to hold down medical costs. Health care is a major expense for most families, and especially in this economy, we owe it to our customers to do everything we can to keep that cost down. Accepting the cost increases pushed by THR would drive up costs for the employers who offer health care to their employees, and to our individual members who cover the cost of their own insurance premiums every month.

We are concerned that THR is demanding an additional $120 million over three years for the same volume and level of services they currently provide.

It is unacceptable for THR to demand that our members and employer groups pay more when THR already makes a 30% profit margin from our BCBSTX members.