Blue Cross Blue Shield and Southwestern Health Resources reach deal on new contract
The companies announced the deal in statements made late in the evening on Friday, April 4.
'Blue Cross and Blue Shield of Texas has agreed to terms with Southwestern Health Resources that protect our members' access to quality care offered by (Southwestern Health Resources) providers at fair prices,' Texas' largest health insurer said in a statement sent to the Star-Telegram.
Blue Cross Blue Shield of Texas insures over 10.4 million people in the state.
All members who lost access to more than two dozen major hospitals in the Metroplex on Tuesday once again have in-network access to Southwestern's medical facilities, and the coverage is retroactive, Blue Cross Blue Shield said.
'Any claims processed as out-of-network on or after April 1 will be reprocessed at the in-network benefit level,' a Blue Cross spokesperson said in the statement.
The agreement will last for three years, according to a spokesperson for Southwestern Health Resources.
'This means all Texas Health and UT Southwestern hospitals, facilities and employed and affiliated providers are in network,' the spokesperson said. 'Patients can keep their scheduled appointment or schedule a new one and be assured that in-network rates will apply. We are honored to continue caring for (Blue Cross Blue Shield of Texas) members as an in-network provider.'
The contract restores coverage to the following Blue Cross Blue Shield plans:
ParPlan
Blue Choice PPO
Blue Essentials
Medicaid
Blue Cross Medicare Advantage PPO
Blue Cross Medicare Advantage HMO
Blue Advantage HMO and MyBlue Health
Over a dozen Blue Cross Blue Shield policyholders reached out to the Star-Telegram this week to express frustration over interruptions to treatment. Several were dealing with recent diagnoses or ongoing treatment for life-threatening illnesses such as breast and thyroid cancer.
'This should not happen to people who get insurance, so they can stay healthy,' said Melanie Perry, who has monthly oncologist appointments as part of her treatment after surgery for breast cancer. 'The greed on both sides greatly affects people's lives — I feel very helpless and scared.'
Speaking with the Star-Telegram on Wednesday about the fallout of the contract expiration, Jonathan Gruber, a healthcare economist at the Massachusetts Institute of Technology, said the situation serves as an example of why the government should regulate prices in the healthcare industry.
'If we regulated prices, there wouldn't be this problem,' Gruber said.
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