Patients culled from care after deal deadlocks

Children's Memorial Hermann Hospital
Mark Chassay, MD - Chief Medical Officer for Blue Cross and Blue Shield of Texas
Networks impacted by the changes

On the heels of a stalled agreement between BlueCross BlueShield of Texas (BCBSTX) and Memorial Hermann health care, patients in Southeast Texas will no longer have in-network access to the physicians and facilities of the greater Houston Memorial Hermann campuses.

As of March 1, BCBSTX customers under the care of a physician in the Memorial Hermann network will be required to seek out provisions that would allow them to temporarily continue the care they currently receive while trying to find alternate care. Affected patients also include those covered by Medicare Advantage programs managed by BCBSTX.

According to information released from Memorial Hermann, the medical facility has been negotiating with BCBSTX for new contracts that “more appropriately cover the care our hospitals and facilities provide across Greater Houston, in addition to our critical physician group and accountable care program agreements that enable us to deliver exceptional and affordable patient care.

“We want you to know that we’ve been working around the clock to reach new agreements, exhausting all options and offering creative solutions that should have been mutually agreeable to all parties.”

A solution agreeable to all parties was not reached, however. March 1, BCBSTX dropped Memorial Hermann from its networks, resulting in more than 265 of Memorial Hermann’s hospitals and care delivery sites, plus approximately 3,000 affiliated physicians and specialists, being no longer under network coverage.

BCBSTX members covered by commercial PPO/POS, EPO, Blue Essentials HMO and Medicare Advantage HMO/PPO health plans are all impacted, as are BCBS out-of-state plan members that access BCBSTX local networks.

Both Memorial Hermann Health System and its clinically integrated physician network (MHMD), in its entirety, are now considered out of BCBSTX’s network. This means that BCBSTX may no longer provide its members with in-network access to Memorial Hermann facilities, such as hospitals or outpatient clinics, or to the network of affiliated MHMD providers.

“While we’ve done everything in our power to work with BCBSTX to ensure our patients can continue to access Memorial Hermann facilities and physicians for care, BCBSTX’s decision to force us out-of-network puts patients at risk of experiencing significant disruption,” the Memorial Hermann announcement further read. “Your health care should be up to you – not your insurance provider.”

Responding to The Examiner’s request for comment or clarification, a statement was provided on behalf of BCBSTX.

“Following months of persistent negotiations, 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 health care professionals are out of the networks,” the statement began. “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 health care professionals have chosen to contract separately to remain in BCBSTX’s network.

“For members whose providers have not chosen to contract directly with BCBSTX,” the company’s communiqué read, “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.”

BCBSTX recommends that members call the customer service number on the back of their ID cards to see if their doctors are still in-network. Members being treated for a pregnancy, disability, acute condition or life-threatening illness may have continuity of care benefits and still be able to see their current doctor at Memorial Hermann – for a little while. To be eligible, BCBSTX members must complete and submit a “Continuity of Care Form” to confirm eligibility and approval for extension of in-network coverage.

Otherwise, to maintain in-network access to Memorial Hermann, patients are advised to speak with employer benefits managers about alternative health plans, and switching Medicare Advantage plans, an option only available through March 31. For those that do nothing, BCBSTX customers that are Memorial Hermann patients will either need to change physicians or expect changes to the costs billed for visits and care.

“This change means you’ll face higher out-of-packet costs when you visit a Memorial Hermann facility,” Chief Medical Officer Dr. Mark Chassay of BCBSTX said. “It also means you may get a bill for additional costs that aren’t covered by your policy.”

Chassay said he understood the importance of members’ access to care, “especially while we remain in a pandemic,” but that could not set aside the fiscal impacts associated with negotiations between the health care provider and insurer.

“We understand you may have concerns or questions,” Chassay added.

Chassay recommended contacting customer service with those questions.

Memorial Hermann facilities no longer in BCBSTX network as of March 1 include:

Memorial Hermann Greater Heights Hospital

Memorial Hermann Heart Vascular Southwest

Memorial Hermann Pearland Hospital

Memorial Hermann Southeast Hospital

Memorial Hermann Southwest Hospital

Memorial Hermann The Woodlands Hospital

Children’s Memorial Hermann Hospital

Memorial Hermann Hospital

Memorial Hermann Cypress Hospital