“We are increasingly concerned that Covenant is using the threat of interrupted treatment and balance billing to secure reimbursement rates that are unreasonable and unsustainable”
Update on Covenant Health and Care Access in Lubbock, TX
SOURCE: CURATIVE INSURANCE COMPANY
We are writing to provide an update regarding Covenant Health’s recent communications and actions indicating that it intends to limit or discontinue access to certain non-emergency services for Curative members. Emergency care will not be affected.
We recognize the uncertainty this creates for members and employers, particularly for individuals currently receiving ongoing treatment or specialty care. We also understand that employers and members have choices, and that continuing to support a healthcare model focused on affordability, transparency, and accountability may not always be the easiest path in the short term.
Despite Curative’s extensive efforts to preserve access to care, we are increasingly concerned that Covenant is using the threat of interrupted treatment and balance billing to secure reimbursement rates that are unreasonable and unsustainable.
Covenant accepts discounted reimbursement from the largest insurers in the market at approximately 33% of billed charges. Yet Covenant is asking Lubbock-area residents and patients to personally carry balances as high as 42% of billed charges before reimbursement or financial assistance mechanisms apply. At the same time, Covenant is demanding even higher reimbursement from Curative for specialty and oncology related care, approaching 55% of billed charges.
We reject Covenant’s allegations regarding historical reimbursement issues. But we nevertheless offered to resolve Covenant’s excessive demands in an effort to avoid further disruption for members and employers. That legacy dispute is proceeding through alternative dispute resolution, yet Covenant continues to treat members’ access to care as leverage in negotiations.
Our priority is to ensure access to necessary care. For members impacted by Covenant’s actions, we will coordinate access to alternative provider systems in Amarillo, Midland, Dallas Fort Worth, and other Texas markets, including subsidized travel assistance where appropriate. Curative also is actively engaged with UMC Health System, and we will provide updates as they become available.
We strongly encourage any affected member receiving treatment or scheduled care to provide the name of their treating physician or specialist as soon as possible so Curative’s clinical and navigation teams can work directly with providers to manage treatment needs or transfer of care as quickly and safely as possible.
We appreciate the partnership and trust of our brokers, employer groups, and members throughout this process. We remain committed to standing with the West Texas employers and families who continue bearing the cost of an increasingly unaffordable healthcare system.
For travel coordination or any care-related concerns, members can reach a Curative Care Navigator directly at carenavigator@curative.com or by texting the number listed on the member portal.
Your broker partner has received a version of this communication and is available to assist with questions, in addition to your account manager. A member-facing communication will follow in the coming days.
Thank you for your continued partnership.
