Over 450,000 patients at UT Southwestern Medical Center and Texas Health Resources could soon lose their in-network coverage because of a contract dispute with the state’s largest insurer, Blue Cross Blue Shield of Texas.
Such conflicts are usually settled before the deadline, and experts expect that in this situation. But unless a new contract is approved by Oct. 4, patients could face hefty out-of-network deductibles and co-pays for treatment from doctors and facilities affiliated with UT Southwestern and Texas Health.
So what can patients do? Here are suggestions from doctors, patient advocates and other experts:
1. Review your health coverage and evaluate your financial exposure.
The cost of care with out-of-network providers can be twice as high or worse – or not so bad.
Understanding the rules of your health plan would help Blue Cross Blue Shield members decide how to proceed if the contract impasse continues.
If patients have a long-scheduled office visit with a doctor – and out-of-network charges are not prohibitive – they might choose to keep the appointment and pay a higher share of costs if necessary. But if they’re planning an expensive procedure , they may want to postpone until there’s a new contract or look for another provider in the network.
“Patients should not panic, because this problem may not come to pass,” said Deb Gordon, co-director of the Alliance of Professional Health Advocates. “But patients affected by the situation should take it seriously and think through what would happen to them . What do they need to do if this goes all the way to terminating the contract?”
In general, experts suggest waiting on a settlement before canceling appointments because most contract disputes are resolved by the deadline. But the stakes are higher for people getting more treatment and for those with thinner coverage.
2. Let your doctor help you through this period.
Dr. Donna Casey, an independent physician affiliated with Texas Health Presbyterian Hospital in Dallas, has been swamped by calls from patients worried about losing network coverage. They want to be seen immediately, and they’re afraid of running out of medicine and missing annual physicals.
Her office has been staying open late, she said, and she’s trying to keep patients from feeling stressed by the insurance situation.
“There’s no need for anxiety and hysteria,” said Casey, president-elect of the Dallas County Medical Society. “Your doctor is going to take care of you, I can guarantee it.”
She urged patients to contact their doctor’s offices and explain their concerns. Doctors can squeeze in appointments and call in prescriptions if necessary. And they won’t let patients run out of diabetes medicine or anti-depressants, she said.
If the Blue Cross contract is terminated – and Casey doesn’t believe it will go that far – she said doctors would try to make the transition as smooth as possible. “We’re going to take care of people, and this just creates another level of disruption.”
3. If you’re being treated now, consider asking to continue care.
Some patients currently undergoing treatment may be able to continue paying in-network rates even if the Blue Cross contract ends on Oct. 4.
So-called continuity of care benefits may be available to pregnant women in their second and third trimester and to others in a course of treatment.
“You don’t just automatically get them; you have to raise your hand and ask for them,” Gordon said.
Both the providers and insurers offer a link to Blue Cross’ application for continuing care, which asks about the patient’s health condition, plans for surgery and other treatment details.
Your doctor can help make the case for getting those temporary benefits, and patients should not be worried about making the request.
“In this situation, providers are on high alert for anyone who would be deeply harmed by disrupting their care,” Gordon said.
4. Become an advocate for your health care.
The contract fight puts all the leading players in a bad light: UT Southwestern, Texas Health and Blue Cross Blue Shield. They already have reason to reach an agreement and end the potential disruptions to their customers’ lives.
But patients could amp up the pressure by calling, explaining the impact on them and urging a speedy resolution, said Jon Roth, CEO of the Dallas County Medical Society.
“You may feel small because you’re one patient calling these huge organizations and complaining,” Roth said. “But if a number of patients share their stories, that only adds more incentive for these organizations to get their deal done.”
He suggested calling your doctor’s office and whom asking to contact at the insurance company and hospital system.
“We’re always a fan of patients being advocates for their own health care,” Roth said.
5. Create a paper trail to help defend against higher rates.
Blue Cross members can always choose another in-network provider, and the insurer said it’s recently reached new contracts with all the major health systems in North Texas. On its website, Blue Cross has a link to a wide range of providers.
For those who plan to continue with their doctors or course of treatment, Gordon suggested they be proactive about requesting an exception. It may be difficult to get the OK, but making the request and documenting your efforts could be helpful in the future.
If there’s a gap in in-network coverage – say it takes a while for the parties to reach a settlement – your efforts to clarify coverage could pay off.
“You’re sort of building your case,” Gordon said. “Document your need and your provider’s support for continuing your care. Make it official, put it in writing, use the formal channels the insurance company offers.”
If you end up with a big bill for out-of-network costs, you can point to those efforts, she said: “It will be much harder to make a case if you haven’t documented your steps.”