More than 450,000 patients at UT Southwestern Medical Center and Texas Health Resources may soon lose their in-network coverage due to a contract dispute with the state’s largest insurer, Blue Cross Blue Shield of Texas.
Such conflicts are usually settled before the deadline, and experts expect that in this situation. But unless a new contract is approved by Oct. 4, patients could face hefty deductibles and co-pays for out-of-network treatment from doctors and facilities affiliated with UT Southwestern and Texas Health.
So what can patients do? Here are suggestions from doctors, patient advocates and other experts:
1. Review your health coverage and assess your financial exposure.
The cost of care at out-of-network providers can be twice as much or worse – or not as bad.
Understanding your health plan’s rules would help Blue Cross Blue Shield members decide how to proceed if the contract impasse continues.
If patients have a long-planned doctor’s office visit — and out-of-network charges aren’t prohibitive — they can choose to keep the appointment and pay a higher share of the cost if necessary. But if they’re planning an expensive procedure, they may want to hold off until a new contract is in place or look for another in-network provider.
“Patients should not panic because this problem may not happen,” said Deb Gordon, co-director of the Alliance of Professional Health Advocates. “But patients affected by the situation should take it seriously and think about what would happen to them.” What should they do if it ends up terminating the contract?’
In general, experts recommend waiting for agreement before canceling meetings, as most contract disputes are resolved by the deadline. But the stakes are higher for people who get more treatment and for those with thinner coverage.
2. Let your doctor help you during this period.
Dr. Donna Casey, an independent physician affiliated with Texas Health Presbyterian Hospital in Dallas, has been inundated with calls from patients worried about losing network coverage. They want to be seen immediately and are afraid of running out of medication and missing annual checkups.
Her office stays open late, she said, and tries to keep patients from feeling stressed about the insurance situation.
“There’s no need for anxiety and hysteria,” said Casey, president-elect of the Dallas County Medical Society. “Your doctor will take care of you, I can guarantee it.”
She urged patients to contact their doctors’ offices and explain their concerns. Doctors can make appointments and call in prescriptions if needed. And they won’t let patients go without diabetes medication or antidepressants, she said.
If the Blue Cross contract is terminated — and Casey doesn’t believe it will go that far — she said doctors will try to make the transition as smooth as possible. “We’re going to take care of people, and it just creates another level of disruption.”
3. If you are receiving treatment now, consider asking for continued care.
Some patients currently being treated may continue to pay in-network rates even if the Blue Cross contract ends on October 4.
So-called continuity of care benefits may be available to pregnant women in their second and third trimesters and others undergoing treatment.
“You don’t just get them automatically; you have to raise your hand and ask for them,” Gordon said.
Both providers and insurers offer a link to Blue Cross’s Continuing Care Application, which asks about a patient’s health status, surgery plans and other treatment details.
Your doctor can help you make the case for receiving these temporary benefits, and patients don’t have to worry about making the claim.
“In this situation, providers are on the lookout for anyone who would be deeply harmed if they violated their care,” Gordon said.
4. Become an advocate for your health care.
The contract battle puts all the major players in a bad light: UT Southwestern, Texas Health and Blue Cross Blue Shield. They now have a reason to settle and end potential disruptions to their customers’ lives.
But patients could add to the pressure by calling, explaining the impact on them and demanding a quick resolution, said John Roth, CEO of the Dallas County Medical Society.
“You can feel small because you’re one patient calling these huge organizations and complaining,” Roth said. “But if a number of patients share their stories, it just adds more incentive for these organizations to close their deal.”
He suggested calling your doctor’s office and asking who to contact at the insurance company and hospital system.
“We’re always fans of patients advocating for their own health care,” Roth said.
5. Create a paper trail to help protect against higher rates.
Blue Cross members can always choose another in-network provider, and the insurer said it recently signed new contracts with all major health systems in North Texas. Blue Cross has a link to a wide range of providers on its website.
For those who plan to continue with their doctors or course of treatment, Gordon suggested being proactive when asking for an exception. It can be difficult to get an OK, but submitting a request and documenting your efforts can be helpful in the future.
If there’s a gap in network coverage—say, it takes a while for the parties to reach an agreement—your efforts to clarify coverage may pay off.
“You kind of build your case,” Gordon said. “Document your need and your provider’s support for continuing care. Make it official, put it in writing, use the official channels offered by the insurance company.
If you end up with a big bill for out-of-network expenses, you can point to those efforts, she said: “It’s going to be a lot harder to make a case if you haven’t documented your steps.”