Ethan Rhodes
Seton Hospital, part of the Ascension Texas hospital system, was at risk of being dropped from the Blue Cross Blue Shield of Texas (BCBSTX) network in early 2023. This was due to a contract dispute between Ascension Texas and Blue Cross, the largest health insurance provider in the state. The contract was set to expire on January 31, 2023, and negotiations were ongoing, causing concern for patients who used Seton Hospital and other Ascension Texas hospitals. However, a deal was reached just days before the deadline, ensuring that Ascension hospitals, including Seton, remained in-network for Blue Cross members.
| Characteristics | Values |
|---|---|
| Name of Hospital | Ascension Seton |
| Name of Insurance Company | Blue Cross and Blue Shield of Texas |
| Number of People Who May Be Affected | 60,000-66,000 |
| Contract Expiry Date | 31 January 2023 |
| Negotiation Status | A deal was reached on 26 January 2023, just days before the contract was set to expire. |
| Hospitals Covered by the Contract | Dell Seton Medical Center, Ascension Seton, Dell Children's Medical Center, Ascension Seton Southwest, Ascension Seton Northwest, Ascension Seton Hays, Ascension Seton Williamson, Ascension Seton Bastrop, Ascension Seton Smithville, Ascension Seton Highland Lakes in Burnet, Ascension Seton Edgar B. Davis in Luling, and Ascension Providence in Waco |
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What You'll Learn
Seton Hospital is part of Ascension Texas
Ascension Seton offers a wide range of specialized care, including robotic surgery options for various surgical specialties, such as bariatrics, general surgery, gynecology, cardiovascular, colorectal, thoracic, neurosurgery, and urology. They also have the only heart transplant program in Austin and the only comprehensive children's heart center in Central Texas. Additionally, they provide orthopedic care for children and adults, advanced spine care, and women's health services, including screenings, gynecologic and maternity care, and specialty care.
In terms of insurance coverage, Blue Cross and Blue Shield of Texas (BCBSTX) is the largest health insurance provider in the state, serving over 6 million members. However, as of January 2023, there were concerns that Blue Cross and Blue Shield might drop Ascension hospitals from their network due to contract negotiations. This could result in higher out-of-network prices for patients with Blue Cross and Blue Shield insurance plans if they chose to go to an Ascension hospital.
While negotiations were ongoing at the time, there was uncertainty about whether a new contract would be signed before the previous one expired on January 31, 2023. This situation highlights the complex dynamics between hospital systems and insurance companies, with potential implications for patients' access to healthcare and their out-of-pocket expenses.
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Blue Cross and Blue Shield contract negotiations
Contract negotiations between healthcare providers and insurance companies are a regular occurrence. In 2023, Blue Cross and Blue Shield of Texas (BCBSTX) and Ascension Texas were involved in contract negotiations that could have impacted over 60,000 people in Central Texas. Ascension Texas hospitals, including Dell Children's Hospital and Dell Seton at the University of Texas, were at risk of being out of network for BCBSTX insurance plan holders. This would have resulted in higher out-of-pocket expenses for families.
The contract negotiations centred around reimbursement rates and contract language. Ascension Texas sought higher reimbursement rates and wanted to prevent BCBSTX from conducting claim reviews. Shara McClure, division vice president for healthcare delivery at BCBSTX, stated that they wanted to "maintain sovereignty" in the negotiations. Despite the potential impact on patients, both parties remained committed to finding a resolution.
In another instance, Excellus Blue Cross Blue Shield in Central New York was involved in contract negotiations with major healthcare providers, including St. Joseph's Health and Trinity Health. These negotiations left patients uncertain about their future healthcare coverage options. Lawmakers urged the parties to negotiate in good faith and prioritize patient care, emphasizing the importance of affordable and accessible healthcare for the community.
Contract negotiations between Memorial Sloan Kettering Cancer Center (MSK) and Anthem Blue Cross also focused on reimbursement rates. MSK advocated for rates that allowed them to continue delivering cost-effective cancer care while maintaining in-network access for Anthem members across the tri-state area.
These examples highlight the complex nature of contract negotiations between healthcare providers and insurance companies, with potential consequences for patients' access to care and out-of-pocket expenses.
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Potential impact on patients
Blue Cross and Blue Shield of Texas is the largest health insurance provider in the state. It provides insurance to over 6 million people, including state employees, University of Texas employees, and teachers. In January 2023, Blue Cross and Ascension Seton hospitals were in negotiation over a multiyear contract that was set to expire on January 31. Ascension Texas includes hospitals such as Dell Seton Medical Center, Dell Children's Medical Center, Ascension Seton, Ascension Providence in Waco, and many others.
If an agreement was not reached, patients with Blue Cross and Blue Shield insurance plans would have to pay out-of-network prices if they chose to go to an Ascension hospital. This would have limited options and added to costs for Austin-area patients. For example, the deductible before insurance begins to pay and the out-of-pocket maximum expenses would have been much higher out-of-network. In many cases, the difference in deductibles and out-of-pocket maximums can be double, costing families thousands of dollars.
However, a deal was reached just days before the contract was set to expire, meaning that Blue Cross and Blue Shield members will have continued access to Ascension hospitals. This includes over 66,000 people who have used Ascension Texas hospitals in the past.
Despite the deal, patients are still wary, as Blue Cross has said that it is possible some customers may get kicked out of the network. If this happens, patients may have to appeal the decision through their insurer.
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In-network and out-of-network costs
Blue Cross and Blue Shield of Texas (BCBSTX) is the state's largest private health insurance provider, with over 6 million members. BCBSTX members have access to a network of healthcare providers, including hospitals, doctors, and pharmacies, with whom BCBSTX has negotiated discounted rates for its members.
Ascension Seton hospitals in Texas are part of the BCBSTX network. However, in early 2023, there were negotiations between Ascension Texas and BCBSTX over contract terms, with Ascension Texas seeking higher costs. This threatened to increase costs for BCBSTX members who used Ascension Seton hospitals, as they would have had to pay out-of-network prices.
Fortunately, a deal was reached, and all Ascension Texas hospitals, including Ascension Seton, remained in-network for BCBSTX members. This meant that members could continue to access healthcare services at these hospitals at the in-network rates negotiated by BCBSTX.
It is important to note that in some cases, BCBSTX may provide in-network rates for out-of-network hospitals. For example, if a member requires emergency services, is in the middle of treatment for a chronic condition, or if there are services that can only be performed at an out-of-network hospital, BCBSTX may offer in-network coverage.
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Alternative options for patients
As of 1 January 2023, Blue Cross and Blue Shield of Texas could drop Ascension hospitals, including Ascension Seton, from their network. This means that people with Blue Cross insurance plans would have to pay out-of-network prices if they choose to go to an Ascension hospital. This could significantly increase costs for patients.
- Medavie: A not-for-profit organization operating within the Canadian health sector, providing health, drug, and dental insurance products.
- Pacific Blue Cross: A health benefits provider offering insurance products, including health, dental, life, disability, and travel coverage for individuals and groups.
- Vitality Health: A company specializing in health and life insurance, providing private healthcare coverage and financial protection.
- Wellnet Healthcare: A company that offers services such as building health plans, managing claims costs, and providing concierge services.
- MyAmeren: A platform associated with Ameren Corporation, focusing on employee services. It provides tools for employees and retirees to manage healthcare, retirement plans, and access various company programs and discounts.
- GreenShield: A health and benefits organization operating as a payer-provider in the healthcare sector, offering insurance coverage and benefits administration.
- Automated Administration Services (AAS): AAS allows organizations to outsource the technical aspects of administering employee benefits.
- Forney Financial Solutions: Offers financial services, including retirement planning, investment guidance, insurance products, and wealth management.
It is important to note that these alternative options may vary depending on the specific location and availability of insurance providers in your area. Additionally, patients with ongoing treatment plans can still pay in-network costs under the law, even if their hospital goes out of network. Patients in this situation should contact their insurance provider to verify their coverage options.
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Frequently asked questions
Seton Hospital is part of the Ascension Texas hospital system. Ascension Texas includes hospitals such as Dell Seton Medical Center, Ascension Seton, Dell Children's Medical Center, Ascension Seton Northwest, and Ascension Seton Hays. In January 2023, Ascension Texas and Blue Cross Blue Shield of Texas were in a contract dispute that could have left thousands of Central Texans out of network. However, a deal was reached just days before their contract was set to expire on February 1, 2023. Therefore, Seton Hospital is currently covered by Blue Cross Blue Shield of Texas.
If Blue Cross and Ascension Texas hadn't reached a deal, people with Blue Cross insurance plans would have had to pay out-of-network prices at Ascension hospitals. This would have limited options and added to costs for Austin-area patients. However, Texas' continuity of care laws require an insurer or hospital to keep a patient in-network if they're undergoing life-saving treatment.
In addition to the hospitals mentioned earlier, other Ascension hospitals that were impacted by the contract dispute include Ascension Seton Southwest, Ascension Seton Williamson, Ascension Seton Bastrop, Ascension Seton Smithville, Ascension Seton Highland Lakes in Burnet, and Ascension Providence in Waco.
Blue Cross Blue Shield of Texas is the largest health insurance provider in the state, with over 6 million members. This includes University of Texas employees, state employees, and folks who receive insurance through the Teacher Retirement System.
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