As of March 1, the Memorial Hermann Health System and BlueCross BlueShield Texas no longer have a contract. This means patients will have to pay out-of-network costs.
Representatives from both organizations said the negotiations are ongoing.
"It's a lose, lose, lose. It's a loss for prospective patients of Memorial Hermann, it's a loss for Memorial Hermann, and it's a loss for Blue Cross Blue Shield," explained Seth Chandler, a law professor at the University of Houston School of Law.
The hospital's contract with the state's largest insurer expired at the start of the month after a disagreement over contracting out the hospital's physician's network.
"I recognize it's incredibly disruptive, but if you don't have a doctor's appointment or a visit, or a hospitalization, or imaging, or something planned for the next several months, I would encourage people to hold on and wait. We will work this out as we move forward," explained Dr. James McCarthy, the chief physician executive of Memorial Hermann.
Some Memorial Hermann physicians contract services independently, so patients should call their medical professionals as soon as possible to determine the best next step.
If you're already in the middle of treatment, you may be able to keep your current coverage, but you'll have to fill out what's called a continuity of care form.
"So a pregnancy, cancer treatment, a long-term surgery," McCarthy explained. "There is a process for those to go forward so that it does not disadvantage the patient so they don't have to go somewhere else or find another doctor."
If you're facing an emergency, you should still go to your nearest hospital. Those extra out-of-network fees won't apply.
"Congress, just this past year, provided additional protection for people visiting emergency rooms against surprise billing from anesthesiologists and the like who happen to be out of network," Chandler explained.
Blue Cross Blue Shield released the following information:
Following months of persistent negotiations, Blue Cross and Blue Shield of Texas (BCBSTX) was unable to reach an agreement with Memorial Hermann to keep the health system in the BCBSTX networks. As a result, Memorial Hermann hospitals, surgery centers, and some doctors and healthcare professionals are out of the networks below effective March 1, 2022.
- Blue Choice PPOSM
- Blue EssentialsSM
- Medicare Advantage PPOSM
- Medicare Advantage HMOSM
We were hopeful throughout the negotiations that we would reach a mutually beneficial agreement, and despite the termination will continue to work towards an agreement. We have great respect for Memorial Hermann as an organization, but we continue to focus on what is best for our members and customers.
Some Memorial Hermann physicians and healthcare professionals have chosen to contract separately to remain in BCBSTX's networks. For members whose providers have not chosen to contract directly with BCBSTX, we are making every effort to make sure members are moved to in-network doctors, hospitals, and surgery centers as seamlessly as possible. We are also working with in-network hospitals to speed up granting privileges to doctors who only have privileges at Memorial Hermann so they can continue to care for our members.
Here are the steps BCBSTX members should take to find in-network doctors and providers:
Call the Customer Service number on your member ID card Search our Provider Finder.
For personalized search results based on your health plan and network, register or log in to Blue Access for MembersSM.
In the case of a life-threatening illness or injury, call 911 or go to the nearest emergency facility right away.
Care for ongoing conditions: Members being treated for a pregnancy, disability, acute condition or life-threatening illness may have continuity of care benefits. This means they may still be able to see their current doctor at Memorial Hermann even after they leave our networks.
Benefits for continuity of care are based on benefit plans. To find out if they are eligible, members can call the number on their ID card for more information.
For more information visit Memorial Hermann or BlueCross Blue Shield's websites.
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