Judge Dismisses Blue Cross Lawsuit Over Low Reimbursement Rates

A federal judge has dismissed a lawsuit against Blue Cross Blue Shield of Texas by 49 physician groups that claim the insurer is not paying enough for emergency medical care. The groups argue the there are 250,000 claims where Blue Cross’ reimbursement rate for out-of-network providers violates Texas insurance laws and regulations. In an emergency, patients are brought to the nearest hospital, which might not always be in network. “As out-of-network providers, the Provider Entities are not contractually bound to accept discounted rates of payment for the emergency medical services they provide to BCBSTX Members and instead expect to receive… Full Story

Dr. Paul Hain promoted to Chief Medical Officer of Blue Cross Blue Shield of Texas

Dr. Paul Hain has been promoted to be Chief Medical Officer and divisional senior vice president market delivery for Blue Cross Blue Shield of Texas after previously serving as president of North Texas Market Strategy for the insurer. Hain is no stranger to D CEO Healthcare, and isn’t afraid to ruffle feathers. He speaks at medical conferences and panel discussions all over the region, and has spoken passionately about why medical costs are the way they are. In his new position, he will oversee public relations, community investments, government relations, and lobbying efforts. His other roles will include executive sponsor… Full Story

Blue Cross President: Drug Prices Have “Lost All Relationship to Any Sort of Sanity”

A Healthcare Cost Institute report named Dallas as one of the most expensive places in the country to get healthcare. At the Dallas-Fort Worth Business Group on Health’s Forum this month, Dr. Paul Hain put the blame at the feet of local consolidation and increased drug prices. The HCCI report is a visually pleasing infographic where one can see how their city’s healthcare costs compare to other metro areas around the country. Called the Healthy Marketplace Index, it names Dallas as the 17th most expensive city in the country in 2016. Overall, DFW’s healthcare costs are five percent above the… Full Story

Rural Hospitals Say They Are Being Strong-Armed By Blue Cross Blue Shield of Texas

Several rural hospitals say that Blue Cross Blue Shield of Texas is using its influence to negotiate unfavorable contracts that slashed reimbursement rates from the insurance company, according to the Texas Observer. The piece features Iraan General Hospital in West Texas, who was already losing over a million dollars a year before new CEO Keith Butler took over and received a new contract from Blue Cross, whose reimbursement provides most of the hospital’s revenue. “I pulled it up and started looking at the contract,” Butler told the Observer. “It was terrible. It would have hurt this hospital a lot.” Butler sent back… Full Story

Blue Cross Blue Shield Teams Up With Texas A&M to Improve Rural Healthcare

In order to address rural healthcare challenges, Blue Cross Blue Shield of Texas is partnering with Texas A&M University in order to learn more about the problems that face these underserved communities and find solutions to solve them. BCBSTX is committing $10 million to the Texas A&M Health Science Center to reduce healthcare costs and improve outcomes by improving health disparities and social determinants of health. They will join other organizations that are working to improve rural healthcare, such as the Dallas-Fort Worth Hospital Council Foundation, who received a Community Mental Health Grant to provide mental health first aid training… Full Story

Blue Cross Blue Shield, UT Southwestern, Texas Health Resources Team Up to Provide Care in North Texas

Blue Cross Blue Shield of Texas and Southwestern Health Resources are coming together to form an Accountable Care Organization that will coordinate services to serve Blue Cross’ more than 130,000 members in North Texas, according to Pharmiweb. The agreement provides access to Southwestern Health Resources Accountable Care Network, which was established as a partnership between Texas Health Resources and UT Southwestern Medical Center that includes doctors, caregivers, hospitals and other facilities throughout the region. An Accountable Care Organization is a group of healthcare providers who voluntarily join to coordinate care to medicare patients. They hope to avoid duplication and errors… Full Story

An Amputee And The Cost Of A Medevac

Doctors amputated Dr. Naveed Khan’s arm after injuries from an ATV crash along the Red River near Wichita Falls, Texas, and his case is a microcosm of the tension between insurance and air ambulance companies. Khan is a 35-year-old radiologist who was enjoying an ATV ride with his friend when he tipped the vehicle and gashed his arm, according to KERA. They rushed to the United Regional Health Care System in Wichita Falls, but he needed to be treated at a trauma center as quickly as possible. The severity of the injury required the medevac ride, according to Dr. Rajesh Gandhi,… Full Story

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