HOUSTON – There’s an impasse between hospital Memorial Hermann and insurance company Blue Cross, Blue Shield that could lead to thousands of patients in our area losing access to their doctors.
Here’s the Blue Cross, Blue Shield side:
“We are offering the doctors and health care professionals an opportunity to contract with us directly and stay in our networks. We’re hopeful that we will reach a mutually beneficial agreement.
If we don’t sign new contracts, Memorial Hermann hospitals, surgery centers, doctors, and health care professionals will no longer be in these provider networks after March 1, 2022:
• Blue Choice PPOSM
• Blue EssentialsSM
• BlueHPNSM
• Medicare Advantage PPOSM
• Medicare Advantage HMOSM
If we can’t reach an agreement, or if our members desire to find another in-network doctor or health care professional, we’ll work with them to safely move their care. For help members can:
• Visit our online Provider Finder®
• Register for or log in to Blue Access for MembersSM
• Call the Customer Service number on your ID card
For more information, please go to: https://www.bcbstx.com/memorialhermann. "
According to Memorial Hermann, this boils down to Accountable Care Organizations (ACO).
ACOs are groups of providers, who come together to ensure that patients get the right care and avoid unnecessary duplication of services.
“So, Dr. A doesn’t know what tests have been done on their patient, doesn’t know what referrals have been done, so you end up getting duplicative care because the data is not being shared,” said Chief Physician Executive for Memorial Hermann Health System Dr. James McCarthy. “They’re going to tell you they’re offering us an ACO agreement, that’s really pretty disingenuous. They’re offering a bolt-on ACO to a small portion of our physicians but intentionally driving most of them into other ACOs that they own and they’re offering them better rates than they’re willing to pay these groups who are trying to stay independent and working together. That’s our main source of friction right now.”
Memorial Hermann recommends patients ask their human resources department to contact BCBS and ask them to come to an agreement.
The two organizations have until Feb. 28 to come to an agreement.
These disputes are not uncommon.
Often there are exceptions for people who are in the middle of treatment to be given a continuity of care exception, despite being out of network with a provider that terminates a contract.
Patients should ask their doctor if they qualify for continuity of care.