Insurance dispute could knock Texas Health Resources off Blue Cross network

With employee open enrollment for next year in full swing, Blue Cross and Blue Shield of Texas and Texas Health Resources, the operator of Harris Methodist, Arlington Memorial and Presbyterian hospitals in the area, remain in negotiations on a new contract to replace the one that expires Dec. 31.

Reimbursement and other matters are at issue, Blue Cross and Texas Health representatives said. Both said they want Texas Health to stay in the Blue Cross network.

Blue Cross is Texas' No. 1 accident and health underwriter, with 27.3 percent of the 2009 market, according to the Texas Department of Insurance.

Without a new agreement, some physicians and Texas Health's 24 hospitals and 18 outpatient facilities would be considered out-of-network for people covered by Blue Cross Blue Shield, said Wendell Watson, a spokesman for the hospital company.

"This is not what we want, and we are working hard to reach a resolution," he said.

Blue Cross Blue Shield spokeswoman Margaret Jarvis said "we have made every reasonable attempt to reach an agreement that will provide a balance of affordable healthcare options on behalf of our clients, and will continue to engage in contract discussions with the goal of making an agreement that benefits our customers."

Jarvis said the negotiations are largely about reimbursements that the insurer will pay for medical services, although other matters are on the table, too. Watson likewise said talks cover more than just rates, but declined to elaborate.

Asked whether Texas Health is seeking an increase in reimbursements, Watson said: "We are seeking a modest, single-digit increase that is below the rate of medical inflation." Texas Health "has begun communicating with employers and patients who have Blue Cross Blue Shield coverage to alert them of the possibility" that it may go out of the network, Watson said.

"It is important that they know that nothing has changed for our patients at this time," Watson said. "They can access care with Texas Health hospitals and physicians who practice on the medical staff the same way they have in the past.

"We have six weeks to reach an agreement," Watson said. "No matter what happens, we'll remain true to our commitment of serving people whether or not our hospitals are in the Blue Cross Blue Shield network."

The negotiations cover all Blue Cross Blue Shield products, including the HMO and PPO, Jarvis and Watson said.

Jarvis said Blue Cross' "biggest challenge is managing the rising cost of medical services today. The major items that most people think of as healthcare costs are rising rapidly, which translates directly into higher health insurance costs," Jarvis said.

Costs for prescription drugs, hospital care and physician services continue to rise, she said.

Scott Nishimura, 817-390-7808