HOUSTON — If your health insurance is with Blue Cross Blue Shield of Texas, you need to read this.
BCBSTX is currently in a contract dispute with Memorial Hermann that appears to be going down to the wire. It's a battle between two Goliaths: The state's largest insurer and the region's largest health system.
Their current agreements for PPO/POS, EPO, Blue Essentials HMO and Medicare Advantage HMO/PPO expire Monday, Feb. 28.
If they don't reach an agreement by then, tens of thousands of patients could be forced to change doctors or get stuck footing the bill beginning March 1.
"This means that claims for services incurred on March 1, 2022 or later from a Memorial Hermann provider may be treated as out-of-network," BCBSTX said in a statement. "Out-of-network services can be significantly more expensive, and we recommend you stay within the HealthSelectSM network to keep your costs as low as possible."
There are approximately 3,000 physicians affiliated with Memorial Hermann, so check with your doctor's office if you're not sure. It would also affect more than 265 Memorial Hermann hospitals, facilities, and clinics.
Emergency care would not be impacted, according to both sides.
What Memorial Hermann patients can do
Memorial Hermann has the following advice for patients on its website.
- Call BCBSTX through the Member Services phone number on the back of your plan ID card. Let them know that it is important you maintain in-network access to Memorial Hermann’s network of providers and facilities to ensure you have options when it comes to your healthcare.
- If you receive health insurance from your employer, speak with your benefits manager. Ask about the potential of alternative health plans that maintain in-network access to Memorial Hermann facilities and providers.
- If you are enrolled in Medicare Advantage, you may be eligible to switch health plans through March 31, 2022. Contact your broker, consult with a trusted family member, or visit this website to review available plan options inclusive of access to Memorial Hermann.
Here are answers to some other frequently asked questions from Memorial Hermann.
Will my upcoming appointments be covered?
"After February 28, BCBSTX will no longer provide authorization for services to be performed at a Memorial Hermann location or with affiliated non-contracted Memorial Hermann physicians, if applicable. Please contact the BCBSTX number on the back of your Member ID Card for additional information regarding available providers."
What if I am pregnant or have another ongoing condition?
"State-mandated continuity of care provisions must be followed," Memorial Hermann says on its website. "BCBSTX requires a continuity of care request form be completed by its members in order to confirm eligibility and approval for in-network coverage.
"We have submitted a large list of patients to BCBS where we believe continuity of care is essential and they should continue to allow them to go on rate structure we 've been going on," said Chief Physician Dr. James McCarthy.
If you have a BCBS plan from Texas, Oklahoma, New Mexico, Montana or Illinois, you can find the continuity of care request form here. These forms should be faxed to the number on the form. BCBSTX may then reach out to you or your physician for more information.
Will I be notified about upcoming appointments?
"A representative from Memorial Hermann will be in contact with you and your physician to confirm any scheduled services and the desire or not to utilize BCBSTX coverage," according to the website.
"If you wish to cancel your currently scheduled service set for March 1, 2022 or after, please either call the same number for scheduling, as may be available, or contact your physician's office for direction. We urge continued communication with your physician as well to ensure they are aware of any concerns."
What are out of network and out of pocket costs?
Memorial Hermann says you can check the potential costs on this patient estimator tool available, which includes self-pay information. You can also contact their Central Pricing Office at (832) 658-6455 for more detailed information or email them at centralpricingoffice@memorialhermann.org.
What if I need to transfer my records?
Memorial Hermann has existing processes for patients to request copies of their medical records or have their medical records transferred to another healthcare provider. This link will take you to the Memorial Hermann Release of Information webpage where you will find information on how to:
- obtain a copy of your medical records;
- transfer your medical records to another health care provider;
- request a copy of your radiology images; and/or
- request a copy of your itemized bill.
Memorial Hermann statement:
"Memorial Hermann is negotiating with BlueCross BlueShield of Texas (BCBSTX) for new agreements that cover the care we deliver to patients who have commercial and Medicare Advantage BCBSTX health plans. The current agreements expire after February 28, 2022.
For more than 15 years, we have had a routine negotiation process in place with BCBSTX, but BCBSTX now has expressed a desire to remove in-network access to Memorial Hermann providers from its networks. This isn’t right.
For now, patients can and should continue to seek care from Memorial Hermann providers and facilities through February 28, 2022. But if our agreements expire, you may lose in-network access to approximately 3,000 affiliated Memorial Hermann physicians across our 265+ locations throughout Greater Houston, effective March 1, 2022.
- Call BCBSTX through the Member Services phone number on the back of your plan ID card. Let them know that it is important you maintain in-network access to Memorial Hermann’s network of providers and facilities to ensure you have options when it comes to your healthcare.
- If you receive health insurance from your employer, speak with your benefits manager. Ask about the potential of alternative health plans that maintain in-network access to Memorial Hermann facilities and providers.
- If you are enrolled in Medicare Advantage, you may be eligible to switch health plans through March 31, 2022. Contact your broker, consult with a trusted family member, or visit https://www.medicare.gov/plan-compare/#/?lang=en&year=2022 to review available plan options inclusive of access to Memorial Hermann."
BCBSTX statement:
"Memorial Hermann notified us of its intent to leave our networks on March 1, 2022 unless we reach agreement on new contract terms.
We are offering the doctors and health care professionals an opportunity to contract with us directly and stay in our networks. We’re hopeful that we will reach a mutually beneficial agreement.
If we don’t sign new contracts, Memorial Hermann hospitals, surgery centers, doctors and health care professionals will no longer be in these provider networks after March 1, 2022:
- Blue Choice PPOSM
- Blue EssentialsSM
- BlueHPNSM
- Medicare Advantage PPOSM
- Medicare Advantage HMOSM
If we can’t reach an agreement, or if our members desire to find another in-network doctor or health care professional, we’ll work with them to safely move their care. For help members can:
- Visit our online Provider Finder®
- Register for or log in to Blue Access for MembersSM
- Call the Customer Service number on your ID card
In the case of a life-threatening illness or injury, call 911 or go to the nearest emergency facility right away. Emergency services for commercial networks are covered at the in-network benefit level.
While we have great respect for Memorial Hermann as an organization, we also have an obligation to do what is best for you, our members, and customers.
For more information, please go to: https://www.bcbstx.com/memorialhermann."