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

A New Old Model That Could Change How Employees Receive Primary Care

Is it possible to get quality primary care without worrying about deductibles, copays, or dealing with the insurance company? An old model is being revamped to simplify primary care and change the incentives. In the fee-for-service model where many primary care physicians are owned by large hospital systems, the incentives for the doctors may be skewed away from patient care and cost. More tests, procedures, and appointments mean more revenue for the doctor or hospital system, and if they are part of a large system, physicians have added pressure to refer their patients to specialists and surgeons in that network,… Full Story

AARP, Business, and Insurer Groups Join Fight to Fix Surprise Medical Bills

Texas advocacy, business, insurer, and public policy groups are teaming up to help fix surprise medical bills. These bills, also known as balance billing, often occur in emergency situations when a patient visits an emergency room and is unable to choose all the doctors they see, resulting in out-of-network care even for an in-network hospital. The resulting bill can be much larger than expected, and there have been moves made in the Texas Legislature to create a mediation system that helps providers and health plans to come together and figure out a fair payment. Despite the current mediation process, which… Full Story

How Much Money Are North Texas Health Plans Making?

The latest version of Allan Baumgarten’s Texas Health Market Review came out this year, revealing enrollment, profit, and marketshare for Texas’ Health Plans for 2017. Some plans appear to be raking in the cash, while others are losing millions of dollars. First, let’s look at what the review says about insured rates in Texas, which has the greatest percentage of uninsured people in the nation. According to the report, Texas’ uninsured rate decreased from 21.9 percent in 2013 to 17.3 percent in 2017, though it ticked up from 16.9 percent since 2015. Texas is one of 14 states that hasn’t adopted… Full Story