Texas Health Resources prepares to go out of network with BCBS

Arlington-based Texas Health Resources said it would continue to provide services regardless of its network status with Blue Cross Blue Shield of Texas. However, after continued failed negotiations, the health system is warning patients of increased likelihood for greater out-of-pocket expenses should THR's contract with the payer expire at the end of the month, according to Community Impact Newspaper.

THR's attempts to extend its contract with BCBS of Texas have not been successful. The proposed extension would give the entities additional time to negotiate a contract between BCBS of Texas and Southwestern Health Resources, the integrated health network THR created with UT Southwestern Medical Center in Dallas. The partnership was established in October 2015 to better serve the rising number of residents in North Texas, according to the report.

BCBS officials said it is unlikely they will reach an agreement at this point in the year. The insurer claims THR is asking for rate increases that would negatively affect BCBS members, according to the report.

"Although we value our relationship with Texas Health, in aggregate, THR is currently the most expensive health care provider in North Texas," BCBS spokesman Chris Callahan said, according to the report. "Texas Health continues to ask for a rate increase that would cause our members to bear the burden of additional unnecessary and unwarranted costs with no guarantee of better health outcomes. As stewards of our members' healthcare coverage dollars, this is unacceptable."

Mr. Callahan said if THR leaves the BCBS network, members in North Texas will still have access to more than 25,000 in-network physicians and 60 in-network hospitals. However, according to THR Chief Clinical Officer Daniel Varga, residents in the Dallas Metropolitan area with BCBS insurance would have a difficult time accessing some basic services if THR is out of network.

"The North Texas marketplace is a rapidly growing marketplace. It's also a marketplace that today is experiencing a significant provider shortage," Mr. Varga said, according to the report. "Having Texas Health Resources and its extensive provider network outside of network means that shortage is only worsened."

More articles on payer issues:
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BCBS of South Carolina adopts coverage for Acessa System

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