Check health plan Jan. 1

Ascension Texas hospitals might no longer be in-network for people who have Blue Cross and Blue Shield of Texas insurance plans starting Jan. 1.

This could mean that anyone with a Blue Cross and Blue Shield of Texas health insurance plan who goes to one of Ascension Texas' 12 Central Texas hospitals after Jan. 1 will have to pay the more expensive out-of-network costs instead of the negotiated in-network costs.

This has happened before. In February 2023, the hospitals went out of network for a few weeks before Ascension Texas and Blue Cross and Blue Shield of Texas reached a new contract agreement.

Blue Cross and Blue Shield of Texas said in a statement: "Our goal is to protect our members' and customers' access to quality care at cost-effective rates."

Ascension Texas said it has been negotiating with Blue Cross and Blue Shield of Texas for many months and hopes the insurance company will return to the negotiation table.

"The contract terms BCBSTX has offered do not address Ascension's financial realities, and those facing health systems across the country, particularly steep increases in equipment and medication costs, some representing the most significant inflation in decades," it said in a statement.

In negotiations

Hospital systems and insurance companies regularly review contracts prior to renewing them. Ascension Seton and Blue Cross and Blue Shield of Texas have been in negotiations for months this fall, but the current contract ends Jan. 1.

Ascension Texas' 11 hospitals had a 2023 operating profit of $284 million, according to the National Academy for State Health Policy's Hospital Cost Toll and Resources. Health Care Service Corporation Group, which owns Blue Cross and Blue Shield of Texas, had a net income in 2024 of $659 million, according to its annual report.

Largest provider

Blue Cross and Blue Shield of Texas is the largest health insurance provider in the state with more than 10.4 million members. They include employees of the city of Austin and the University of Texas, state employees and people who receive insurance through the Teacher Retirement System.

This potential change would affect people who have plans Blue Choice PPO, Blue Essentials, Blue Advantage HMO, My Blue Health, Blue Premier, Blue HPN, Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO). If your plan is not listed here and it is through Blue Cross and Blue Shield of Texas, call the number on your insurance card to see if you will be impacted.

What does it mean?

Most people who have Blue Cross and Blue Shield of Texas insurance plans would have to pay out-of-network prices if they chose to go to an Ascension hospital. In-network versus out of network status affects how high the deductible is before insurance begins paying, as well as the out-of-pocket maximum the point at which the insurer starts covering 100% of costs. These amounts vary by plan, but in many cases the difference in deductibles and out-of-pocket maximums are double for out-of-network care,costing families thousands of dollars.

Ascension Texas

Ascension Texas hospitals and their clinics are Dell Seton Medical Center at the University of Texas, Ascension Seton Medical Center, Dell Children's, Ascension Seton Southwest, Ascension Seton Northwest, Ascension Seton Hays, Ascension Seton Williamson, Ascension Seton Bastrop, Ascension Seton Smithville, Ascension Seton Highland Lakes in Burnet, Ascension Seton Edgar B. Davis in Luling and Ascension Providence in Waco.

This does not affect most of the doctors who are at Ascension Texas hospitals because they have separate contracts with the insurance company.

There are services at these hospitals that cannot be replicated at other Central Texas hospitals. Ascension Texas includes Austin's highest trauma level hospital, Dell Seton, and the highest trauma level care for children at Dell Children's. Dell Seton also has the only burn unit in Central Texas; Ascension Seton has the only heart transplant program; and Dell Children's has the only pediatric cardiac team that can do the highest level of care such as heart transplants and mechanical hearts.

Possibly covered

There are situations that could still be covered at in-network rates by Blue Cross and Blue Shield of Texas.

If someone has an emergency or a trauma and is at a facility that is out-of-network, it is treated as in-network.

If someone is in the middle of treatment for a chronic condition, a life-threatening situation or acute situation, or just had surgery and is doing follow-up care, or if they are pregnant and have an established relationship with a hospital and doctor in that hospital, those cases can be considered "continuity of care." The patient and provider can apply to receive in-network coverage.

If there are services that can only be done at an out-of-network hospital in Central Texas, those can be given in-network coverage, after approval.

If an agreement is not reached by Jan. 1, but is reached soon after, it is possible that Blue Cross and Blue Shield would give people who were caught in the gap in-network rates. That has happened in the past.

Call to verify

Blue Cross and Blue Shield of Texas and Ascension recommend that people call the insurance number on the back of their card to verify coverage and out-of-pocket expenses before a scheduled procedure or health test at an impacted hospital or before going to a clinic that might be impacted.