66,000 could lose access to this Austin hospital network by the end of the month. Is your coverage changing?

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AUSTIN (KXAN) – Blue Cross Blue Shield of Texas says 66,000 of its insured patients received care at Ascension hospitals and surgical centers last year – ongoing contract negotiations between the companies could terminate access to these healthcare facilities if not there is agreement.

A statement from Ascension Texas to KXAN said the current agreement with Blue Cross Blue Shield of Texas will end at the end of January.

This would make more than 50 hospitals, centers and surgical centers out of network for patients in and around Austin, as well as in Waco. Dell Children’s Medical Center among them.

We reached out to the hospital system after several policyholders messaged us at ReportIt@KXAN.com.

The statement read in part: “Without a commitment to reasonable terms, our current contract with BCBSTX will end on January 31, 2023 for commercial and Medicare Advantage members of BCBSTX.”

KXAN also received a statement from Blue Cross Blue Shield of Texas that said this change would affect more than 60,000 patients – starting first with the exclusion of Ascension Hospitals on February 1st, moving on to excluding physicians and healthcare professionals by mid-summer.

The statement read in part: “To protect our members, we have sent Ascension a termination notice for physicians and healthcare professionals employed by Ascension. If we are unable to reach a reasonable agreement, physicians will leave the Blue Choice PPO, Blue Essentials and Medicare Advantage (PPO) networks on May 1. Physicians and healthcare professionals will also leave the Blue Advantage HMO network on June 15th. ”

Both companies encourage members to verify their coverage using the policy information on their member identification cards.

‘I feel like a pawn’: patients involved in contractual battle

Claire Tapscott is excited to be a new mom. Her birth plan includes delivering her daughter at Ascension Seton hospital, but an email from the health system on Monday sent her into a panic. Her plan was in trouble.

“I just panicked, trying to figure out, is my doctor going to be covered? Will hospitals be covered?” Tapscott said.

After calls to BCBSTX, she learned that her hospital of choice as of Feb. 1 would no longer be covered by her insurance without the companies agreeing to a partnership.

Her gynecologist would still be covered, but Tapscott says she wasn’t sure she had hospital privileges at any other hospital in the area.

That gave her two options: stay with the doctor at the risk of paying out-of-network prices at another hospital if he had privileges there — or find a new OBGYN, health staff and hospital a month from the due date.

“I am 34 weeks pregnant. And I love my doctor, I don’t want to find a new doctor. I feel like a pawn, I feel like patients are pawns in this conversation,” said Tapscott.

BCBSTX is accepting ‘continuity of care’ applications – this entitles members treated for pregnancy, disability, acute condition or life-threatening illness to receive in-network fees at Ascension facilities if they leave their network.

The insurance company asks members to verify their eligibility by calling the number on their membership identification card.

While doctors and healthcare professionals won’t be taken out of the network until May 1 and again on June 15 – Michael Wilson, father of three, says he’s worried.

One of her children has a chronic condition that requires regular visits to specialists. He says this change would alienate his son from the doctor who already knows his needs and treatment.

“I think as the larger entities struggle, it seems like the patients are the ones that get squeezed in the middle,” Wilson said.

BCBSTX has provided this web page for updates on ongoing negotiations. Ascension also provided its own webpage.

Ascension and BCBSTX say they are working to reach an agreement.

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