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Blue Cross Blue Shield of Texas, CHI St. Joseph Health negotiations could lead to loss of in-network rates

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Posted at 4:46 PM, Oct 21, 2020
and last updated 2020-10-21 17:47:16-04

BRYAN, TX — Blue Cross Blue Shield of Texas (BCBSTX) and CHI St. Luke’s Health are currently in negotiations regarding pricing as BCBSTX members could potentially no longer see in-network rates before the end of the year.

At a time when healthcare is at the center of attention, Blue Cross Blue Shield of Texas and CHI St. Luke’s Health, which comprises of 16 hospitals located in Houston, Bryan/College Station, and East Texas, are in negotiations regarding pricing for 2021.

“They notified us in June, right in the middle of a global pandemic and economic crisis, that they would no longer be in our network as of December 16, 2020, unless BCBSTX agreed to some pretty unreasonable and high demands that they had to raise their prices,” said Shara McClure, Divisional Senior VP of Texas Health Care Deliveries, BCBSTX.

According to CHI. St. Luke’s Health, BCBSTX has reimbursed at rates far below those of other similar healthcare providers in the market, which has forced them to terminate the contract and renegotiate.

“Actually, we did have a deal with CHI CommonSpirit that went through 2021, and then they decided that they were not willing to abide by that deal, and you know they exercised their right and they had the right to exercise termination from the contract, so that’s what they did,” said McClure.

In a statement provided to 25 news from CHI St. Luke’s Health, CEO Dr. Doug Lawson said, “It is unfortunate that Blue Cross Blue Shield of Texas has not been more willing to reimburse at levels that enable us to provide essential services. We were forced to issue the notice in an effort to motivate Blue Cross Blue Shield of Texas to agree to rates that enable us to preserve access and care to critical health services for the patients we serve throughout our region.”

Blue Cross Blue Shield of Texas says their ultimate goal is to provide affordable healthcare.

“Healthcare is expensive, and I think a lot of people know that healthcare is expensive, which is a part of the reason people need health insurance, but it’s our role to make sure members are getting the best deal and, again, more affordable healthcare, not unexpected price increases for the same services that they’ve been accessing,” said McClure.

With the proposed increases by CHI St. Luke’s Health, BCBSTX says 60% of their members that are self-insured would be paying for those increases.

“So any price increase would actually hit those businesses directly, and a lot of those businesses are tax-based organizations. They’re universities like Texas A&M University. They are trying to find ways to control expenses. We are trying to find ways to make healthcare more affordable, and this is the kind of thing that will make healthcare less affordable,” said McClure.

While negotiations are still underway between the two, Dr. Lawson says it's “CHI St. Luke’s Health sincerest hope and belief that they can work together to achieve a reasonable agreement to ensure access to essential services are available for patients and employers across the region.”

In 2019, more than 10,000 inpatient hospitalizations across the 16 hospitals in the Texas division were from BCBSTX members who also had 150,000 outpatient visits and procedures.