Blue Cross and Blue Shield of Texas Working to Transition Members to Providers in Houston and Southeast Texas

By: James T. Campbell
| Published 12/17/2020

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RICHARDSON, TX -- Following months of extensive negotiations, Blue Cross and Blue Shield of Texas (BCBSTX) was unable to reach an agreement with CommonSpirit Health, the parent company of CHI-St. Luke’s Health, to keep the health system in the BCBSTX networks.

The negotiation started after CommonSpirit Health sent a termination notification on June 19 of its intent to leave the BCBSTX networks on Dec. 16, 2020. The health system demanded double-digit increases in the prices BCBSTX members pay for care.

BCBSTX made a generous offer to CommonSpirit, which they chose not to accept. Now, they are out-of-network for all networks except MyBlue Health?.

“Despite our best efforts to avoid disrupting our members and their patients during a pandemic, CommonSpirit Health made the choice to leave our networks,” said Shara McClure, BCBSTX’s divisional SVP, Texas Health Care Delivery. “Their demands come as businesses have suffered huge financial losses, with many of our customers forced to lay off thousands of employees. As well, their demands would drive up the cost of health care in the Houston and southeast Texas region, which already has some of the highest prices in the nation.”

Now, BCBSTX is making every effort to make sure members are moved to other doctors, hospitals and surgery centers as seamlessly as possible. 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.

“Understandably, any change to the BCBSTX provider networks is cause for concern for our members,” McClure continued. “We’ve contacted other in-network hospitals and they’ve assured us that they can and will welcome our members. Our priority is to help our members experience as little inconvenience as possible as they change to other quality, credentialed healthcare providers in our network.”

Physicians who work at CommonSpirit Health were not part of this negotiation. Moreover, many doctors have privileges at other hospitals, or they can apply for privileges at other in-network hospitals.

“Right now, we are working with in-network hospitals to speed up granting privileges to doctors who only have privileges at CommonSpirit Health, so they can continue to care for our members,” McClure said. “We encourage our members to talk with their doctors about their care options.”

BCBSTX members being treated for a disability, acute condition, life-threatening illness or are in the second trimester of pregnancy (or as set forth in their health plan), may be covered by what is known as “continuity of care.” This means members may still be able to use CommonSpirit Health facilities at the in-network level of benefits.

Members who are eligible for continuity of care, will not be balance billed or have to pay more than the amount covered by their plan, even if CommonSpirit Health charges more.

For questions or help filling out the continuity of care request form, BCBSTX members can call the number on your member ID card. Customer advocates will help answer questions about specific benefits and provide guidance.

For more information, click on this link.

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