Medical Center Hospital patients who have Blue Cross Blue Shield of Texas insurance are getting a letter this week from MCH explaining an approaching deadline that could impact BCBS customers if negotiations are not successful.
MCH CEO Russell Tippin said Tuesday negotiations have been going on for months between MCH and BCBSTX on the amount that BCBSTX pays to MCH. The current contract ends May 31 and if negotiations are not successful MCH will become an out of network BCBS provider.
Tippin said the amount that BCBSTX pays MCH is the lowest in the region and that the rate has not changed in five years although all healthcare expenses continue to rise especially after COVID.
Tippin said 52,000 letters were mailed Tuesday to anyone who has been a patient at MCH during the last several years and who is insured by BCBSTX.
Tippin, Chief of Staff Gregory Shipkey and Communications Director Trevor Tankersley on Tuesday explained what BCBSTX being out of network would mean to Ector County residents and patients at MCH.
Tippin explained they hope the negotiations are successful but also said if an agreement is not reached that when a BCBSTX patient comes to MCH “we will still give you care” but that how much the patient initially pays out of pocket will change.
More specifically, Tippin used a colonoscopy as an example. “Right now a Blue Cross patient may come in and be charged $1,000 and BCBSTX is charged the remaining $2,000 and we file with the insurance meaning the patient paid the $1,000 up front.”
However, using that same example Tippin said if no agreement is reached the patient will pay $3,000 to MCH and then the patient will seek the $2,000 reimbursement back from BCBSTX.
The MCH letter includes information on how BCBSTX subscribers can call BCBSTX and ask them to negotiate an agreement that is fair to both BCBSTX and to MCH and to keep MCH in network.
“The costs for us are not going down and we realize that premiums are not going down for subscribers either,” Tippin said. “We want to treat patients and always do what is right. We are not requesting anything other than what everyone else is currently receiving. We are not asking BCBSTX for a whopping increase but to get us to where we need to be so we can continue to serve patients.”
Tippin and Shipkey said negotiations with BCBSTX have been ongoing and have not broken down. “We are still talking and we have a lot of big numbers and spreadsheets with 250,000 lines and there has been a lot of back and forth,” Tippin said.
Shipkey also pointed out that Odessa is an expensive place to live and recruiting can be difficult and adds to the overall cost of healthcare.
“You can get paid more in DFW and it costs less to live there,” Shipkey pointed out factors that make healthcare expensive.
Both agreed costs continue to go up and BCBSTX needs to pay MCH in line with what other health systems are getting.
“Healthcare costs are always upward moving,” Tippin said of costs the hospital faces.
Both pointed out that MCH is being paid less from BCBSTX than most healthcare systems in the area including Midland.
MCH and BCBSTX have been at this point before during the last 20 years resulting in BCBSTX going out of network at MCH a couple of times until an agreement was hammered out.
The letter details:
- It is important to know that nothing will change before May 31. You should keep any scheduled appointments and continue to see your MCH providers as normal.
- Call the number on the back of your health insurance card. Ask BCBSTX to reach a new agreement to protect your in-network access to MCH, its physicians and outpatient clinics.
- If you receive your health insurance through your employer, talk to your human resources representative about your desire for continued in-network access to MCH, its physicians and outpatient clinics.
- For more information, please visit our website at mchodessa.com/accesstocare.
