Amid Court Battle, BCBS Ends Contract with Knox County Hospital for Federal Employees

Federal employees and retirees in Knox County received notice a day after open enrollment ended that their local hospital would no longer be in-network for Blue Cross Blue Shield’s Service Benefit Plan. In a statement sent to the Times-Record News, BCBS of Texas said the following plans would not longer have Knox County Hospital District in network for the following plans. ParPlan Blue Choice PPOSM Blue EssentialsSM Blue Advantage HMOSM The company directed patients to hospitals 20 and 40 miles away to remain in-network. The statement sent to the Times-Record continues, “Members being treated for a pregnancy, disability, acute condition… Full Story

Cigna and SWHR Reach a New Three-year Agreement

After coming dangerously close to severing the in-network ties between one of the largest providers and one of the largest insurers in North Texas, Cigna and Southwestern Health Resources have come to an agreement that will keep Cigna members in-network at Southwestern Health Resource facilities for the next few years. The three-year deal became effective on January 1, avoiding an interruption of in-network coverage. The agreement lasts until Dec. 31, 2022, and keeps all Texas Health Resources and UT Southwestern hospitals, facilities, and doctors in-network until then. “Southwestern Health Resources, on behalf of Texas Health Resources and UT Southwestern Medical… Full Story

$9 Million in Potential Fraud, Waste, and Abuse Found in Fort Worth’s Medical Spend

It is estimated the one in three dollars spent on healthcare are fraud, waste, or abuse, but companies are finding their niche in rooting out the wasted healthcare spend. Most employers would love to reduce their health spend by 3-5 percent, especially if it didn’t entail reducing benefits, kicking spouses off the plan, or making employees pay more for their health insurance. For a $100 million company, this could mean $5 million in savings without a change in benefits. Dallas-based Smartlight Analytics says it can save self-funded employers that much or more by focusing on fraud, abuse, overpayment, and waste. Smartlight… Full Story

UnitedHealthcare’s Has a New Local CMO for Medicare and Retirement

Dr. Kenneth Adams will be the Chief Medical Officer for Medicare and Retirement of UnitedHealthcare in Texas. He arrives from VBHealth where he was CEO. Adams was also Chief Medical Officer at Pro Care Advantage, where he helped developed models of care for Medicare Advantage in nursing homes. “We are excited to add this strong physician executive with significant Medicare experience to our team in Texas,” wrote Dr. James Metcalf, Chief Medical Officer of Medicare and Retirement for the West Region in United Healthcare.  

“There is No Silver Bullet” for Fixing Texas’ Uninsured Problem: D CEO Breakfast Panel Recap

Last week, D CEO and the Dallas Regional Chamber hosted another installment of our D CEO Healthcare Breakfast Panels. We were fortunate to have some of the brightest minds in health insurance join us and educate guests on what is next for health insurance in North Texas. With representatives from the C-suites of Blue Cross Blue Shield of Texas, UnitedHealthcare, Cigna, and Texas Health Aetna, we discussed what role the major health insurers have in everything from improving the social determinants of health to price transparency. Improving the social determinants of health is not an easy task, but research shows… Full Story

Cigna Contract with Southwestern Health Resources Could End Jan. 1

The new year may mark the end of a relationship between two of the largest players in the local healthcare industry, as Southwestern Health Resources and Cigna have been unable to agree to a new contract, meaning SWHR will be out of of network for Cigna members on January 1. The conflict centers upon the connection between cost and quality, and how each organization measures them. The conflict could impact hundreds of thousands of people across the region. Over the past 18 months, there have been 136,000 interactions between Cigna members and SWHR, 66,000 of those interactions were at SWHR… Full Story

Texas Medical Board Withdraws Surprise Billing Rules

The Texas Medical Board is changing its tune about how to interpret Texas’ latest surprise billing legislation. Last week, controversy arose about rules written by the Texas Medical Board in the interpretation of Senate Bill 1264, which was meant to prevent patients from being involved in the balance billing process, were criticized for creating a large loophole for physicians to exploit. Critics said the rules would have put confusing paperwork in the hands of patients, with a potential result being that patients may sign away their protections under the new legislation. The Texas Medical Board said it would not have… Full Story

Most Texas Individual Marketplace Health Plans Are Getting Cheaper

On the individual marketplace, the average cost of health insurance is down 14 percent from 2018 to $508 per month, according to the 2020 Health Insurance report from LendingTree. Nationwide, the individual marketplace for health insurance has stabilized with decreased premiums, attracting companies like Oscar to return to North Texas and Blue Cross Blue Shield of Texas to enter the market. Enrollment in the marketplace peaked in 2016, with more than 1.3 million people selecting plans. In 2019, that number was down to just over a million. There are eight insurers in the Texas marketplace this year, including Blue Cross… Full Story

Texas Can Expand Coverage Without Expanding Medicaid – Here’s How

Texas remains one of 14 states in the country that has yet to expand Medicaid, as its Republican leadership has refused to accept more federal money for expanding health insurance to more of our state’s poor families. DFW’s hospitals are behind Medicaid expansion, in part because Dallas is the largest city with the worst insured rate in the nation. Nationwide, 5.7 percent of children don’t have health insurance, but in Dallas county, that number is 14.3 percent. A number of factors have also decreased the number of children in rolled in CHIP. Hospitals (via taxpayers and consumers) end up paying… Full Story

Texas’ Balance Billing Legislation May Be Threatened by Loophole

Consumer advocates are worried that a proposed rule could undo the protections in Texas’ balance billing legislation. After a law was passed this summer to keep Texas patients out of arbitration between providers and insurers when there are surprise medical bills, some worry that a loophole in the legislation will be used to confuse patients and increase balance billing. Stacey Pogue, a senior policy analyst with the Center for Public Policy Priorities, says that the Texas Medical Board is proposing a rule to implement the law that would expand the use of a section of the law for patients who knowingly… Full Story