HOUSTON — Memorial Hermann and Blue Cross Blue Shield of Texas didn't reach an agreement, meaning the region’s largest health system has been dropped from the state’s largest insurer.
The current agreements for PPO/POS, EPO, Blue Essentials HMO and Medicare Advantage HMO/PPO expired on Monday, Feb. 28.
Without the agreement, tens of thousands of patients will be forced to change doctors or get stuck footing the bill beginning March 1.
"This means that claims for services incurred on March 1, 2022 or later from a Memorial Hermann provider may be treated as out-of-network," BCBSTX said in a statement. "Out-of-network services can be significantly more expensive, and we recommend you stay within the HealthSelectSM network to keep your costs as low as possible."
There are approximately 3,000 physicians affiliated with Memorial Hermann, so check with your doctor's office if you're not sure. It will also affect more than 265 Memorial Hermann hospitals, facilities, and clinics.
Emergency care will not be impacted, according to both sides.
Here are answers to some other frequently asked questions from Memorial Hermann.
Will my upcoming appointments be covered?
"After February 28, BCBSTX will no longer provide authorization for services to be performed at a Memorial Hermann location or with affiliated non-contracted Memorial Hermann physicians, if applicable. Please contact the BCBSTX number on the back of your Member ID Card for additional information regarding available providers."
What if I am pregnant or have another ongoing condition?
"State-mandated continuity of care provisions must be followed," Memorial Hermann says on its website. "BCBSTX requires a continuity of care request form be completed by its members in order to confirm eligibility and approval for in-network coverage.
"We have submitted a large list of patients to BCBS where we believe continuity of care is essential and they should continue to allow them to go on rate structure we 've been going on," said Chief Physician Dr. James McCarthy.
If you have a BCBS plan from Texas, Oklahoma, New Mexico, Montana or Illinois, you can find the continuity of care request form here. These forms should be faxed to the number on the form. BCBSTX may then reach out to you or your physician for more information.
Will I be notified about upcoming appointments?
"A representative from Memorial Hermann will be in contact with you and your physician to confirm any scheduled services and the desire or not to utilize BCBSTX coverage," according to the website.
"If you wish to cancel your currently scheduled service set for March 1, 2022 or after, please either call the same number for scheduling, as may be available, or contact your physician's office for direction. We urge continued communication with your physician as well to ensure they are aware of any concerns."
What are out of network and out of pocket costs?
Memorial Hermann says you can check the potential costs on this patient estimator tool available, which includes self-pay information. You can also contact their Central Pricing Office at (832) 658-6455 for more detailed information or email them at centralpricingoffice@memorialhermann.org.
What if I need to transfer my records?
Memorial Hermann has existing processes for patients to request copies of their medical records or have their medical records transferred to another healthcare provider. This link will take you to the Memorial Hermann Release of Information webpage where you will find information on how to:
- obtain a copy of your medical records;
- transfer your medical records to another health care provider;
- request a copy of your radiology images; and/or
- request a copy of your itemized bill.
Memorial Hermann statement:
Memorial Hermann responded on Twitter Tuesday after an agreement couldn't be reached. They released a video statement from Dr. James McCarthy, Executive Vice President and Chief Physical Executive.
"For the last six months, we've been negotiating with them for new contracts for our health system, our essential physician group and accountable care organization that enables us to deliver exceptional and affordable patient care. We want you to know that we've done everything in our power to work with them at this time, working around the clock while exhausting all options and offering creative solutions that should have been mutual agreeable to al parties. You can see the full video statement here.
The twitter threat that came with it, read, "For the past six months, Memorial Hermann Health System has been negotiating with BlueCross BlueShield of Texas (BCBSTX) for new contracts that more appropriately cover the care our hospitals and facilities provide across Greater Houston, in addition to our critical physician group and accountable care program agreements that enable us to deliver exceptional and affordable patient care. Despite our diligent and tireless efforts to reach an agreement, we are disheartened to share that BCBSTX has dropped us from its network, effective today, March 1, 2022. As a result of its inflexible position, BCBSTX has disrupted care for thousands of our shared patients and members. Memorial Hermann remains committed to engaging with BCBSTX in meaningful discussions that put our patients first."
BCBSTX statement:
"Following months of persistent negotiations, Blue Cross and Blue Shield of Texas (BCBSTX) was unable to reach an agreement with Memorial Hermann to keep the health system in the BCBSTX networks. As a result, Memorial Hermann hospitals, surgery centers, and some doctors and healthcare professionals are out of the networks below effective March 1, 2022.
- Blue Choice PPOSM
- Blue EssentialsSM
- BlueHPNSM
- Medicare Advantage PPOSM
- Medicare Advantage HMOSM
We were hopeful throughout the negotiations that we would reach a mutually beneficial agreement, and despite the termination will continue to work towards an agreement. We have great respect for Memorial Hermann as an organization, but we continue to focus on what is best for our members and customers.
Some Memorial Hermann physicians and healthcare professionals have chosen to contract separately to remain in BCBSTX’s networks. For members whose providers have not chosen to contract directly with BCBSTX, we are making every effort to make sure members are moved to in-network doctors, hospitals, and surgery centers as seamlessly as possible. We are also working with in-network hospitals to speed up granting privileges to doctors who only have privileges at Memorial Hermann so they can continue to care for our members.
Here are the steps BCBSTX members should take to find, in-network doctors and providers:
- Call the Customer Service number on your member ID card § Search our Provider Finder®.
- For personalized search results based on your health plan and network, register or log in to Blue Access for MembersSM.
In the case of a life-threatening illness or injury, call 911 or go to the nearest emergency facility right away.
Care for ongoing conditions: Members being treated for a pregnancy, disability, acute condition or life-threatening illness may have continuity of care benefits. This means they may still be able to see their current doctor at Memorial Hermann even after they leave our networks.
Benefits for continuity of care are based on benefit plans. To find out if they are eligible, members can call the number on their ID card for more information."