Health provider, insurer spar over deal Ascension, Blue Cross Blue Shield dueling over Texas coverage

A major Texas health care network and a major Texas insurance company continue battling over a new contract. Failure to strike a deal by month's end could mean fewer in-network options for thousands of Central Texans.

The combatants are Ascension Texas, parent of Ascension Providence in Waco, and Blue Cross and Blue Shield of Texas. At risk are patients who have coverage through Blue Cross and want or need treatment at an Ascension-branded hospital or surgery center in the state, including Waco.

Ascension Texas said in a statement it continues to negotiate contract terms "that will ensure BCBSTX policyholders maintain in-network access to Ascension Texas hospitals, physicians and hospital-based clinics including Dell Children's Medical Center, and select joint venture facilities, including Ambulatory Surgery Centers."

The statement says that "without a commitment to reasonable terms" Ascension's agreement with Blue Cross will end Jan. 31 for Commercial and Medicare Advantage members.

Ascension Texas is urging patients to contact Blue Cross and Blue Shield of Texas for details about how their coverage might be affected, instructing them to use the number on the back of their insurance card "to express concerns."

Blue Cross and Blue Shield, meanwhile, says it is working to strike a deal that will keep costs in check.

"We value the care Ascension provides our members, but it is already one of the most expensive health systems in the Austin and Central Texas area," a Blue Cross and Blue Shield of Texas statement says. "As a customer-owned health insurance industry leader in Texas for more than 90 years, it is important to stand up for affordable care, especially in a time when most businesses and our members in the Austin and Central Texas region are facing inflationary pressures and a potential recession."

Without a deal, Ascension doctors would be removed from the Blue Choice PPO, Blue Essentials and Medicare Advantage networks on May 1, and doctors and health care professionals would leave the Blue Advantage HMO network on June 15, according to the statement.

Blue Cross and Blue Shield of Texas takes issue with Ascension over its rapid expansion in Texas in recent years. It specifically mentions the Ascension Seton health system serving Austin, saying, "It has purchased multiple specialist groups and ambulatory surgery centers, immediately increasing the costs for patients of those acquired doctors and facilities."

"Studies show health care consolidation leads to higher prices and does not necessarily lead to higher quality care for our members," the statement says.

It says Blue Cross "is willing to pay fair rates, but our members should not expect to supplement shortcomings Ascension is having in other states." It notes Ascension is headquartered in St. Louis and has more than 2,600 sites of care, including 139 hospitals in 19 states.

Blue Cross and Blue Shield of Texas, meanwhile, calls itself the largest provider of health benefits in the state, "working with nearly 80,000 physicians and health care practitioners, and 500 hospitals to serve 6 million members in all 254 counties."

The Austin American-Statesman reported 66,000 people with Blue Cross and Blue Shield of Texas insurance availed themselves of Ascension hospital or clinic services during the past year.

Blue Cross said should an agreement not be reached, it will do all it can "to help members move their care to quality, cost-effective, in-network hospitals and health care professionals."

Its statement says emergency or trauma services at any hospital, regardless of an existing contract, are covered at in-network rates for Blue Cross members.