HOUSTON — After months of failed negotiations, Blue Cross Blue Shield of Texas officially dropped Memorial Hermann Health System on Tuesday, March 1.
That means they will no longer cover Memorial Hermann hospitals and other facilities or non-contracted Memorial Hermann doctors.
Tens of thousands of patients are impacted by the stalemate. And patients like Marisol Gonzalez say they’re the ones paying the price. She gave birth to her second daughter three months ago. Now both of their doctors are out of network.
“You spend time as a mother looking for a pediatrician you’ll feel comfortable taking your kids (to). When you hear that, it’s so disheartening. I know my story is so minimal compared to the thousands that are due for surgery or moms that are about to give birth,” Marisol said.
RELATED: Memorial Hermann, Blue Cross Blue Shield in standoff that could affect your insurance coverage
KHOU 11 News talked to a patient who had a major hip reconstruction surgery a few days ago and is supposed to have another surgery later this year.
Heather wanted to share her story but remain anonymous. She filled out a continuity of care request form to stay with her doctor with in-network coverage. She’s concerned her request will be denied for speaking out.
“Nobody is taking into consideration the patient or the person. Right now, they’re worried about a document and a dollar sign, and that’s pretty frustrating,” Heather said.
Heather hopes she’ll be able to stay with her doctor. Otherwise, she’ll have to delay her next surgery or look for a new doctor.
Many patients are frustrated as they try to navigate the issues.
“It’s hard news to get and it adds to the stress on top of everything else,” Marisol said.
What patients should do
Here are the steps BCBSTX says members should take to find, in-network doctors and providers:
- Call the Customer Service number on your member ID card
- Search the BCBSTX website's Provider Finder
- 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. You can find the continuity of care request form here.
Memorial Hermann statement
Memorial Hermann responded on Twitter on 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 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."
You can see the full video statement here.
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."