Health care stalemate could leave patients with fewer options

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by SHELLY SLATER

Bio | Email | Follow: @wfaashelly

WFAA

Posted on December 9, 2010 at 6:01 PM

Updated Thursday, Dec 9 at 7:16 PM

Negotiations between Blue Cross Blue Shield of Texas and Texas Health Resource hospitals are getting ugly.

It's a deal that affects 800,000 health insurance consumers, including every state employee.

Texas Health Resources has 24 hospitals, 18 outpatient facilities and 5,500 physicians statewide. Locally, that includes facilities including Texas Health Presbyterian Dallas, Texas Health Harris Methodist Hospital Fort Worth and many others.

It is the region's biggest health care network.

If you have Blue Cross Blue Shield coverage, you may have already received information by mail from both sides.

The contract between the two groups expires at the end of this month, but we've just learned there is an "ultimatum" on the table.

So what does this mean for you — especially if you're planned for surgery or are delivering a baby in the new year?

The negotiations started in July, but they could take a drastic turn any day now. The sticking point is money.

Texas Health Resources says it needs to be better compensated for the $3 billion in care it provides to Blue Cross members.

"This week, Blue Cross Blue Shield shifted gears from negotiations to take it or leave it," said Texas Health Resources spokesman Wendell Watson. "They now refuse our invitation to negotiate and gave us an ultimatum — accept their November offer in a week or Blue Cross will drastically cut its offer."

Blue Cross, however, says it is still willing to negotiate.

"At issue is Texas Health Resources' demand for an additional $120 million that would ultimately be paid by [the insured] for the same level of service," Blue Cross Blue Shield said in a statement.

So what now for patients?

Women in their third trimester can qualify for continuing care if they deliver after the December 31 deadline.

But a Blue Cross member with an elective procedure planned at a Texas Health Resources hospital would be now considered "out of network" — meaning the patient would have to pay more for the same operation.

Coverage through the end of this month remains the same.

Blue Cross says if Texas Health Resources leaves its network, there are 50 general acute care hospitals from which its members can choose.

E-mail sslater@wfaa.com

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