Texas’ biggest health insurer may drop these Tarrant County hospitals from some plans

Time is running out for Texas’ biggest health insurer to negotiate a new contract with a hospital network that includes over two dozen North Texas hospitals.

Blue Cross Blue Shield of Texas and Southwestern Health Resources have until April 1 to reach an agreement.

If they don’t work out a deal, 25 North Texas hospitals — including Texas Health Harris Methodist, Texas Health Presbyterian and UT Southwestern — will no longer be in-network for holders of seven Blue Cross Blue Shield of Texas policies.

The full list of hospitals that will be cut from the network in those plans also includes 15 behavioral health facilities, 28 imaging and diagnostic centers, 15 surgery centers, two physician groups and one urgent care center in the Metroplex.

A spokesperson for Blue Cross Blue Shield of Texas said the provider values the care Southwestern Health Resources provides its members and is working closely with the network to reach a deal.

“Our customers are our priority,” the spokesperson said in a written statement. “As the oldest, largest, only customer-owned health insurer in Texas for more than 95 years, our goal is to protect our members’ and customers’ access to quality care at affordable rates.”

If they don’t reach a deal, policyholders will still have access to “a robust network of doctors, health care professionals, hospitals, and facilities throughout North Texas,” the spokesperson said.

“Members who are pregnant or are being treated for a disability, acute condition or life-threatening illness may qualify for continuity of care,” the spokesperson said, clarifying that those who qualify would continue to receive care at Southwestern facilities at in-network rates.

The spokesperson declined to provide more details about the negotiations.

A spokesperson for Southwestern Health Resources said negotiations are ongoing, and it is “not uncommon for conversations to continue right up until the deadline.”

Such contract discussions often take until the last minute to get hammered out, but one detail about the hospitals spooked a North Texas health insurance broker who requested his name not be used out of job security concerns.

He balked at the notion that negotiations tend to go up to the literal last minute. He also found that the entries for some of the hospitals in question do not appear on the Blue Cross Blue Shield database of providers for the plans under negotiation.

“In my years of watching, it’s the first time that I physically saw them remove the hospitals out of their network,” the broker said. “That is a conscious effort that you have taken as a company to remove all those hospitals.”

Searching for specific hospitals on the database does bring up physicians within those hospitals. The broker said he suspects the company simply hadn’t removed them yet.

“They took the effort and they spent the manpower,” the broker said. “Could have been a click, who knows? But they took the manpower time to physically remove those facilities.”

This gave him a “sneaky suspicion something might go down bad.”

Most of the plans under negotiation are on the federal health insurance marketplace Healthcare.gov, also known as Obamacare.

The broker said that cutting Southwestern’s hospitals out of these plans would “completely decimate the market for the self-employed individual in the state of Texas, who generally is the one that buys Obamacare.”

The Blue Cross Blue Shield spokesperson assured the Star-Telegram that all Southwestern hospitals are still in-network and will only be removed if the companies are unable to reach an agreement by April 1.

She said the issue may have been caused by the searches being done as guests, rather than through policyholders accounts.

She and another staffer showed some of the hospital entries were on the database for some plans via a video chat. However, the Star-Telegram’s searches for certain hospitals under plans such as Blue Cross Blue Shield of Texas’ Medicare plans were not.

“I’m seeing a more aggressive trend to where you’re removing them from the network to where, if a client gets on there and searches, there’s no Presbyterian, there’s no Harris Methodist, and that’s what’s got us more concerned than normal,” the broker said.

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