Dispute Between Blue Cross and Blue Shield of Texas and Health Systems Resolved

Blue Cross and Blue Shield of Texas and two major health systems agreed on a new contract late Friday, ending a saga that had thrown thousands of North Texans into confusion.

The insurer and Southwestern Health Resources, which includes UT Southwestern and Texas Health Resources, announced the new agreement at about 9:30 p.m.

The insurer’s announcement said the new agreement is retroactive to April 1. The health system’s announcement said the new agreement will last for three years.

Background of the Dispute

The two powerhouses had spent months in negotiations over the new contract, but did not reach a new deal by the time the previous contract expired on April 1. With the contract lapsed, Blue Cross and Blue Shield of Texas plan holders were suddenly unable to use UT Southwestern or Texas Health Resources providers at the previous in-network rates.

It’s not clear how many people were impacted by the lapse.

The Teacher Retirement System of Texas, which has self-insured plans for active and retired educators through Blue Cross and Blue Shield of Texas, estimated there were 25,000 educators impacted by the lapse. Most of the impacted educators are in Dallas-Fort Worth, where large school districts including Dallas and Fort Worth have opted into the plans.

Impact on Individuals

When major players have disputes such as this one, it causes “a lot of uncertainty for individuals,” said Benjamin Ukert, a health economist at Texas A&M University. He said contract disputes between insurers and health care providers are common, as they typically renegotiate contracts every few years.

“You will see that disputes are coming up all the time,” Ukert said.

Teacher Retirement System chief health officer Katrina Daniel said on Friday morning, before the dispute was resolved, that the lapse in coverage was “frightening” for people to navigate.

The lapse also affected other insurance plans, including Medicaid and employer-based plans.

Personal Stories

Keller resident Hunter Mixson was worried about being forced to change doctors because of the contract dispute. Mixson had a heart attack and emergency open heart surgery a year and a half ago, when he was 29 years old.

Although he lives a fairly normal life now, he still faces possible complications. He said that if anything goes wrong with his heart again, he wants to be able to return to his doctors at Texas Health Resources and UT Southwestern.

“If something else were to happen again, I would like those doctors to be able to take care of me, but they are not in-network anymore,” Mixson said on Friday morning, before the contract dispute was resolved.

Concerns and Resolution

Both Mixson and Daniel said they wanted the dispute to be resolved.

But Daniel also had concerns about higher costs under a new deal, particularly for self-funded plans like the ones that the Teacher Retirement System operates.

A 2% or 3% premium increase could mean hundreds of dollars per year for individual educators and their families, Daniel said.

“We are concerned about the care disruption as well, but the long-term impact is higher cost,” she said on Friday morning.

In its Friday night announcement, Blue Cross and Blue Shield of Texas wrote that any claims that were processed as out-of-network during the lapse would be retroactively corrected.

The insurer and the health network both have additional information posted on their websites. Blue Cross and Blue Shield of Texas also wrote in its announcement that members can call the number on their insurance cards with additional questions.

Conclusion

The resolution of the dispute between Blue Cross and Blue Shield of Texas and the health systems is a welcome relief for thousands of North Texans who were affected by the lapse in coverage. While the dispute has been resolved, it highlights the complexities and uncertainties of the healthcare system, and the need for transparency and communication between insurers, healthcare providers, and patients.

FAQs

Q: What happened to the contract between Blue Cross and Blue Shield of Texas and the health systems?

A: The contract between Blue Cross and Blue Shield of Texas and the health systems, including UT Southwestern and Texas Health Resources, expired on April 1, and a new agreement was not reached until late Friday.

Q: How many people were affected by the lapse in coverage?

A: It’s not clear how many people were impacted by the lapse, but the Teacher Retirement System of Texas estimated that 25,000 educators were affected.

Q: What does the new agreement mean for patients?

A: The new agreement means that patients who have Blue Cross and Blue Shield of Texas insurance can once again use UT Southwestern and Texas Health Resources providers at in-network rates.

Q: What if I received care during the lapse in coverage?

A: According to Blue Cross and Blue Shield of Texas, any claims that were processed as out-of-network during the lapse will be retroactively corrected.