HOUSTON — The stalemate continues between the largest health care system in our area and the largest insurer in Texas.
As of Tuesday, thousands of Blue Cross Blue Shield members were given the option of changing doctors or paying more expensive, out of network costs for staying with Memorial Hermann.
Michele Washburn already had a surgery scheduled for Friday at Memorial Hermann when her coverage ended. Her husband, David, said her knee had been causing excruciating pain for months, so they decided to go ahead with the surgery.
“We had to pay for it before they started the surgery. It cost me $2,300. I had to let my mortgage payment go to allow that to happen,” Washburn said.
RELATED: Memorial Hermann, Blue Cross Blue Shield in standoff that could affect your insurance coverage
The Richmond couple is among the tens of thousands of people impacted by Blue Cross Blue Shield dropping Memorial Hermann over failed contract negotiations.
In some cases, patients can fill out a continuity of care form to get an extension to stay with their doctors. Otherwise, they could get stuck footing the bill. You can find the continuity of care request form here.
David says his wife works for a cleaning service company, so she spends her days on her feet.
“We had to have the surgery done so she can have a halfway normal life, so she can continue to work. Without her having a job, it’s hard for us to pay our bills,” he explained.
He’s disappointed the impasse has gotten to this point. He’s concerned more people will be put in the same position the longer it drags on.
Memorial Hermann statement
“We are doing everything in our power to work with BlueCross BlueShield of Texas (BCBSTX) to ensure our patients can continue to access Memorial Hermann facilities and physicians for care, however BCBSTX’s decision to force us out of network puts patients at risk of experiencing significant disruption. This is deeply frustrating, and it isn’t right. Rest assured that Memorial Hermann will continue to do everything we can to reach an agreement that brings all of these critical resources back in-network, so patients can get the trusted care they need.
We understand some patients had appointments scheduled on or after March 1, 2022. If this is the case, they should call BCBSTX at the number on the back of their Member ID card to see if their procedure may be covered through Continuity of Care, which would maintain their in-network benefits and prevent disruption to their care and treatment. If they choose to keep their appointment as scheduled, they may be subjected to higher out-of-pocket costs because BCBSTX no longer considers Memorial Hermann as an in-network provider.
As healthcare providers, first and foremost, we made every effort possible to work with BCBSTX in good faith before our contracts expired because our patients always come first. We remain open to dialogue that moves us forward and hope that patients will urge BCBSTX, just as we are continuing to do, to work with us to find a mutually agreeable outcome for everyone very soon.
We encourage patients to visit www.ChooseMH.org for up-to-date information regarding our negotiations, and to learn more about how they can maintain their in-network access to Memorial Hermann.”
RELATED: Memorial Hermann, Blue Cross Blue Shield of Texas fail to reach agreement, deal expired on Monday
BCBSTX statement
We are continuing to work towards an agreement for Memorial Hermann to rejoin our networks. But we also understand that any change to the Blue Cross and Blue Shield of Texas’ (BCBSTX) provider networks is cause for concern for our members. Our priority now is to help our members experience as little inconvenience as possible as they change to other quality, credentialed healthcare providers in our network.
To date, BCBSTX has contracted separately with more than 1300 community doctors and health care professionals previously affiliated with Memorial Hermann to prevent disruption while continuing ongoing negotiations. These doctors care for more than 103,000 of our members. More doctors are joining our networks daily. This will allow our members to continue seeing these doctors at in-network rates.
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. The latest information on in-network doctors is in our Provider Finder®. We also encourage our members to please check back if they don’t find the doctor they’re looking for.
Meanwhile, 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. We encourage our members to talk with their doctors about their care options.
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.
For more information, please go to: https://www.bcbstx.com/memorialhermann