The health insurance company warned customers
of potentially huge medical bills
Author: Jake
Harris Published: 9:53 PM CDT April 23, 2019 Updated: 1:22 PM CDT April 24, 2019
DALLAS — Clarification, April 24,
2019: This story has been updated to clarify that services provided by
in-network hospital staff at out-of-network ERs are still covered by BCBS of
Texas.
Customers who have health insurance with Blue
Cross Blue Shield of Texas could face skyrocketing bills if they use certain
hospital emergency room doctors that are no longer in network after
negotiations failed between BCBS and the emergency room contractor, according
to a statement from BCBS. The change is effective immediately.
When a patient walks into to an ER, they might
assume the ER is run by the hospital it's attached to. That's not always the
case. Many ER doctors are actually employed by outside contractors that pair
with hospitals.
That's what's happening here, where Texas Health
Resource ER doctors work for a contracting company called Texas Medicine Resources.
In the statement, which was also sent to all
BCBS Texas customers, the largest health insurance provider in Texas said that
as of April 15, Texas Medicine Resources (TMR) ER doctors who work at several
Texas Health Resources hospitals will be out of network.
"Since these outside companies are not in
our network, there are no limits to what their providers charge, potentially
resulting in significantly higher out-of-pocket costs," the letter reads.
The hospitals themselves, which include Texas
Health Harris Methodist Hospital, Texas Health Presbyterian Hospital Dallas and
Texas Health Arlington Memorial Hospital, will still be in the Blue Cross Blue
Shield network, but certain doctors who work in TMR ERs will not.
"TMR terminated their contract with BCBSTX,
choosing to leave the networks," BCBS Texas media and public relations
director Chris Callahan wrote in a statement to WFAA. "BCBSTX worked hard
to keep the doctors in network, unfortunately, their demands were
unreasonable."
Callahan stressed that only the doctors are
out-of-network, so services performed by hospital staff at these ERs would be
covered at in-network pay levels. But it's the ER doctors who now have the
ability to charge a patient more than the insurance might.
Check out the map below to see which ERs have doctors
who are no longer in-network.
The ER doctors are located at the following
hospitals:
- Texas
Health Arlington Memorial Hospital
- Texas Health Harris Methodist
Hospital Alliance
- Texas Health Harris Methodist
Hospital Azle
- Texas Health Harris Methodist
Hospital Cleburne
- Texas Health Harris Methodist
Hospital Fort Worth
- Texas Health Harris Methodist
Hospital Hurst-Euless-Bedford
- Texas Health Harris Methodist
Hospital Southwest Fort Worth
- Texas Health Harris Methodist
Hospital Stephenville
- Texas Health Presbyterian
Hospital Allen
- Texas Health Presbyterian
Hospital Dallas
- Texas Health Presbyterian Hospital
Denton
- Texas Health Presbyterian
Hospital Kaufman
- Texas Health Presbyterian
Hospital Plano
- Texas Health Presbyterian
Hospital Rockwall
Customers who do go to these ERs will likely
face steep bills, the letter warns.
"You may get multiple bills, including one
from Texas Health and one from Texas Medicine Resources. This can vary based on
the care you received.
"Because they are out of network, Texas
Medicine Resources doctors can charge you more than our allowed amount."
BCBS urged its members to double-check which
hospitals are in-network, and to use an in-network urgent care center or
hospital in the case of an emergency.
An emergency, according to BCBS' website, includes
"life-threatening" symptoms like:
- Heart
problems
- Breathing problems
- Heavy bleeding
- Broken bones
- Severe pain
An urgent care
visit, according to BCBS' website, includes, but is not limited
to:
- Colds,
sore throat and flu symptoms
- Ear or sinus pain
- Rashes
- Cuts that don’t need stitches
- Constipation
- Tolerable pain
BCBS is the largest
health insurer in the state of Texas.
What's next? Senate Bill 1264, authored by Senator Kelly Hancock
(R-North Richland Hills),would eliminate balance billing from doctors who
choose to remain out of insurance networks. The bill passed the Senate last
week and now awaits a vote in the House.
The full statement sent to BCBS insurance
customers (emphasis BCBS'):
Dear Member:
We want you to know that as of April 15, 2019,
the emergency room (ER) doctors at many Texas Health Resources (Texas Health)
facilities are no longer in our network. Texas Health is a
network facility, but most of its ER doctors work for an outside company, Texas
Medicine Resources.
Hospitals across the nation are hiring outside
companies to run their ERs and employ the doctors, nurses and other health
professionals you see when you visit the ER. Since these outside companies are
not in our network, there are no limits to what their providers charge,
potentially resulting in significantly higher out-of-pocket costs.
We try to negotiate contracts with these outside
companies to bring and keep them in network, so you won't have to pay more for
services. In some cases, they choose not to contract with us.
Things to know about emergency care at Texas
Health:
- While
the facilities listed on the following page remain in our network, the
doctors with Texas Medicine Resources who staff their ERs are out
of network as of April 15, 2019.
- You may get multiple bills,
including one from Texas Health and one from Texas Medicine Resources.
This can vary based on the care you received.
- Because they are out of
network, Texas Medicine Resources doctors can charge you more than our
allowed amount.
All plans help pay for medically necessary
emergency care services. Go to the nearest hospital or urgent care when you
have a true emergency.
Our goal is to serve your health care coverage
needs through all of life's changes. If you have any questions, call us at the
number on your member ID card. Our team stands ready to help.
Sincerely,
Your Customer Advocates
Blue Cross and Blue Shield of Texas
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