Can a Coalition of Local Cities Bring Price Transparency and Consistency to Healthcare?

Estimates say around $40 billion every year is spent on healthcare in Dallas-Fort Worth, and as prices continue to increase, all entities are looking for ways to bring down costs. A coalition of 30 cities and the greater DFW area came together in 2015 to form the North Texas Coalition to bring more transparency, sustainability, and predictability to the healthcare market. The coalition hopes to use strength in numbers to get bids directly from regional hospital systems for healthcare services. Some members of the coalition have seen dividends from this strategy. Fort Worth saved $19 million in healthcare spending in… Full Story

How Concentrated is the Texas Health Insurance Market?

According to data from the Government Accountability Office, the three largest private insurers held at least 80 percent of the large group health insurance market in 43 states. Overall, the three largest private health insurers held 80 percent of the employer market in 2015-2016, as first reported in Becker’s Health Review. Compiled from data submitted to the Centers of Medicare and Medicaid, the report reveals that Blue Cross Blue Shield parent company Health Care Services Corporation held 45.2 percent of the overall large group health insurance market in 2016, down from 49.2 percent in 2014. Texas’ three largest private insurers had… Full Story

Lawsuit Forces Blue Cross Blue Shield of Texas to Pay $75,000 to Deaf Applicant

A federal judge signed a decree requiring Richardson-based Blue Cross Blue Shield of Texas to pay a deaf woman $75,000 and other relief for violating the Americans with Disabilities Act, as first reported in the Dallas Morning News. The U.S. Equal Employment Opportunity Commission announced the results of its lawsuit against BCBS of Texas this week. According to the lawsuit, a deaf woman named Sheryl Meador applied online to be a claims examiner, and was asked to complete an assessment with an audio portion. The assessment did not have accommodations for hearing-impaired applicants, and Meador was unable to complete it. The… Full Story

Blue Cross Blue Shield of Texas Parent Company More Than Tripled Profits to $4.1B in 2018

Health Care Services Corporation, the parent company for Blue Cross Blue Shield of Texas, did not pay federal taxes in 2018 and netted $4.1 billion, receiving a $1.7 billion tax refund last year, according to financial statements. In 2017, the company had a net income of $1.3 billion, an increase of over 315 percent for this year. The tax overhaul passed by Congress and increasing profitability of health insurance played a large role in the increase, according to Axios. Profits don’t include fees from self-insured employers pay to HCSC, and the Affordable Care Act Marketplace was a big winner for HCSC.… Full Story

North Texas Hospital CEO Pleads Guilty to Millions in Fraud

Former Palo Pinto General Hospital CEO Harris Brooks pleaded guilty to defrauding BlueCross BlueShield of Texas, CIGNA Texas, and United Healthcare for millions of dollars, according to U.S. Attorney for the Northern District of Texas Erin Nealy Cox. An FBI investigation revealed that Brooks and his co-conspirators used the hospital’s in-network contracts with the insurance companies to defraud them for laboratory services from September 2017 to June 2018. They used a process called pass-through billing, where a physician orders a service but that physician does not actually complete the service for which he or she billed. They submitted claims for allergy… Full Story

What You Might Not Know About Medicare

As Baby Boomers retire in greater and greater numbers, they often look to Medicare to provide their healthcare needs as they age. Navigating the web of Medicare plans can be arduous and time consuming, so here are some important things to know about enrolling. First, you are not enrolled in Medicare automatically. If you are not receiving Social Security benefits, then you have to enroll yourself. Secondly, Medicare is not free. While Medicare Part A (hospital stays, hospice, home health, and skilled nursing) is covered, Medicare Part B (outpatient doctor visits) will cost around $135 a month. It is automatically… Full Story

Expert Opinion: Medicare For All

In North Texas, we treat patients in our hospitals who support many cultural doctrines, so we steer clear of political discussion. We always try to advocate for public policy that improves coverage and treatment. We also strive to educate the community on emerging healthcare issues. With that said, let’s discuss the single-payer system. It is a healthcare system where one entity – a single payer – collects all healthcare fees and pays for costs. The most popular “single payer” approach is called “Medicare for All.” While no details on coverage and funding have emerged, the discussion has centered on allowing… Full Story

Local Lawmaker Introduces ‘Landmark Legislation’ to Fight Surprise Medical Billing in Texas

North Texas State Senator Kelly Hancock authored Senate Bill 1264 to address surprise billing in the state, prohibiting out-of-network providers from sending surprise bills when patients don’t have a real choice of provider. The bill will make patients responsible for applicable co-pays, coinsurance, and deductibles with no additional charges after mediation between the provider and health plan. Data from the Texas Association of Health Plans says that 30 percent of all ER physician services are out of network, even though 65 percent of those services occur at hospitals that are in network. Freestanding emergency rooms account for 83 percent of all out-of-network… Full Story

Medical City and Blue Cross Parent Companies Voted Most Ethical

HCA Healthcare, the parent company of the Medical City hospitals, and Health Care Services Corporation, Blue Cross Blue Shield of Texas’ parent company, were both recognized by the Ethisphere Institute as two of 2019’s World’s Most Ethical Companies. Ethisphere has been evaluating the positive impact of international corporations since 2007, and celebrates the growing influence of value-based leadership, diversity and inclusion, and a constructive use of a company’s voice in corporate operations. The organization believes that financial value and ethics are linked, noting that the companies listed on the most ethical list outperformed companies with large market capitalization by over… Full Story

Blue Cross Teaming Up With 11 Texas Institutions to Address Healthcare Costs

Richardson-based Blue Cross and Blue Shield of Texas will be teaming up with 11 universities to address the root causes of high cost of health care. The research institutions and insurer will be working on projects that focus on behavioral health, vaccine adherence, and analyzing usage data to improve efficiency.  The collaboration is part of Blue Cross’ Affordability Cures initiative, and hopes to address care delivery, unequal distribution, and waste in the system. “Failure to address access and affordability of health care has real consequences. We need to challenge the status quo by bringing transformative research and ideas to the table,”… Full Story