BCBSTX Emergency Room Claims Policy Proceeds Without Changes From TDI

A Blue Cross Blue Shield of Texas policy that has garnered controversy officially went into place on Monday. The policy implements a review process for HMO members that could leave those members on the hook for their entire bills if they visit an out-of-network ER for a non-emergency. In May, the Texas Department of Insurance got the insurer to delay implementation of the rule for 60 days so that TDI could meet with BCBSTX representatives to learn more about the plan. BCBSTX members were first notified of the policy in April. A spokesperson for the insurer said Wednesday that no… Full Story

Baylor Scott & White’s ACO Signs A Deal With BCBSTX

Baylor Scott & White Quality Alliance inked an agreement with Blue Cross Blue Shield of Texas on Tuesday to bring 140,000 of the insurer’s members under its purview. BSWQA is the accountable care organization of Baylor Scott & White Health, encompassing 6,000 primary and specialty care physician members, 50 hospitals, and 95 post-acute care facilities. ACOs are set up to tie payments to quality metrics, with reimbursements based on improving outcomes and cutting costs. The agreement goes into effect this month. The organizations are not releasing financial terms. “Members enrolled in this new ACO arrangement have access to BSWQA’s comprehensive… Full Story

BCBSTX Agrees To 60-Day Delay In Implementing New ER Claims Policy

The Texas Department of Insurance has coaxed Blue Cross Blue Shield of Texas into a 60-day delay in implementing a policy that could leave some members on the hook for their entire emergency room bills. TDI Commissioner Kent Sullivan met with BCBSTX President Dr. Dan McCoy on Tuesday—with other representatives from both sides also in on the meeting—to discuss the new rules, according to a spokesperson for TDI. The department on Thursday sent a letter requesting more information on the change. BCBSTX notified members in April that HMO members visiting out-of-network ERs could be on the hook for their entire… Full Story

UnitedHealthcare North Texas Snags Former BCBSTX Chief of Staff

United Healthcare North Texas has a new vice president of network management, who came over after serving in various high-up roles at Blue Cross Blue Shield of Texas. JJ White is the new hire. She did her undergrad at the University of North Texas. At BCBSTX, White was most recently a divisional vice president for network innovation & strategy, and she served as chief of staff prior to that. She’d been with Blue Cross in one capacity or another since the mid-1990s. White started at UnitedHealthcare in April.

Blue Cross Blue Shield of Texas Becomes the Latest To Target Non-Emergency ER Visits

Blue Cross Blue Shield of Texas is following in the footsteps of other insurers by clamping down on emergency room visits it deems non-emergency. In a memo that made the media rounds this week, BCBSTX says HMO members could be on the hook for their entire medical bills if they go to out-of-network emergency rooms “as a convenience for a condition they don’t think is serious or life-threatening.” Members who’ve made such claims to date will get letters laying out their care options on May 1, and the new review process will kick in on June 4, the memo says.… Full Story

Texas Health, Blue Cross Blue Shield of Texas Ink Four-Year Contracts in Final Hour

Texas Health Resources and Blue Cross Blue Shied of Texas have come to terms on new four-year contracts to keep the Arlington-based system in-network for BCBSTX plan holders. With the deal set to expire at midnight on Sunday morning, the two sides signed within the final hour, a spokesperson for the insurer says. A short statement from BCBSTX says the agreement came together “through determined efforts from both sides.” “We were diligent in our negotiations, we used all the time we had available to us,” BCBSTX Market President Dr. Paul Hain added over the phone this morning. “We wish were… Full Story

Texas Health, Blue Cross Blue Shield of Texas Find Themselves in Another Contract Dispute

A little more than a year after Texas Health Resources and Blue Cross Blue Shield of Texas ended a contract impasse in the final hour, the two sides again find themselves in a dispute. The current contract between the two parties runs through March 31. If they aren’t able to reach a new agreement by then, Texas Health care sites will be out of network for BCBSTX plan holders. The BCBSTX side of the equation says negotiations are hung up on what they classify as $1 billion in increased payments over the life of a four-year contract, as well as… Full Story