By AMANDA KIMBLE
ERATH COUNTY (December 27, 2016) – The clock is counting down to the expiration of an agreement between the area’s largest network of hospitals and physicians and the state’s leading health insurance provider.
As of Tuesday, Texas Health Resources had not reached an agreement that will allow patients insured through Blue Cross Blue Shield of Texas (BCBSTX) to remain in-network when receiving care at Texas Health facilities, including the Stephenville hospital and more than two dozen other hospitals across the region.
For some patients, failed negotiations could mean a search for new doctors, specialists and mental health care providers outside of the local area beginning January 1.
Texas Health Resources said its hospitals and physician groups will continue to provide services to existing patients, but out-of-pocket expenses will most likely increase for those who receive care out of network.
Meanwhile, several health care providers who have privileges at the Stephenville hospital are not a part of Texas Health Physicians Group. Those patients will only be affected when their care requires inpatient services.
“Stephenville Medical and Surgical Clinic remains in-network, and it’s important for the community to understand that there is – and will continue to be – accessible and available healthcare,” Donita Jones, clinic administrator said.
SMSC is an independent practice and certain doctors, such as Dr. Del Rudy, urologist, and Dr. Stephen Erck, surgeon, have privileges at Glen Rose Medical Center.
The Somervell County hospital, Lake Granbury Medical Center and facilities in Comanche and Eastland could offer options for local patients if BCBSTX and Texas Health Resources don’t reconcile their differences, but patients are responsible for determining which of the hospitals offer the services they need and maintain agreements with their insurance provider. Jones explained that Glen Rose Medical Center doesn’t offer the complete line of services that are available locally, including a child birth facility.
“Our biggest single concern is our OB patients who have Blue Cross,” Jones said.
For now, everyone is in the same position – watching the clock and waiting to see if an agreement is met in the 11th hour. While uncertainty looms, Jones suggested that patients take a proactive approach and explore their options.
“Patients who have a scheduled procedure coming up should contact the hospital and Blue Cross to see how they will be affected financially,” she said. “Being out-of-network is so much more expensive.”
Providers and other employees are facing the same circumstances as SMSC patients.
“We don’t have a say or voice in this situation,” she said. “Blue Cross is also our health insurance provider; we will also be impacted.”
Many others could also be impacted. Texas Health said in a recent advertisement that more than 150,000 North Texans will be affected, with about 90 percent of behavioral health patients being unable to find an in-network hospital dedicated to behavioral health. The healthcare network also said almost half of new parents will be required to transfer their sick newborns long distances for neonatal intensive care.
In addition to individuals whose employment benefits include BCBSTX health insurance, a growing number of North Texans are getting their medical coverage through the Affordable Care Act and the federal government’s Health Insurance Marketplace. Open enrollment for 2017 coverage is underway with a January 31 deadline for obtaining new coverage or making updates and changes to existing plans.
A marketplace navigator, an individual trained to assist individuals with signing up for mandated health insurance through healthcare.gov in Erath, Hood and surrounding counties, said she had not been made aware of the issue until being contacted by The Flash in late December.
Meanwhile, the issue is a cause for concern for many Erath County residents. In the public sector, employees of Tarleton State University and Erath County are among those that could be affected by the failed partnership. The university ranks at the top of the Stephenville Chamber of Commerce’s list of major area employers.
In the private sector, FMC Technologies and Walmart employees are among the community members who will be impacted if an agreement is not met, and there are many others on that list.
For those who felt trapped with BCBSTX, Stephenville is home to other healthcare options. Deidre Loredo, office manager at Affordacare Urgent Care Clinic, said BCBSTX plans and others from a number of insurance providers are accepted at their facility, located at 2857 West Washington Street.
Affordacare specializes in minor injuries, adult and pediatric illness, physical examinations and offers community members an option for healthcare when primary care providers are not available. The clinic is open from 8 a.m. until 7 p.m. Monday through Saturday and from 10 a.m. until 4 p.m. on Sunday.
“In the case of a medical emergency, we will still refer patients to the ER,” Loredo said.
The message from Texas Health on emergency care is similar. The network is reminding patients that their emergency rooms are always open and the cost of services is not impacted by a patient’s network status.
Meanwhile, Michelle Beck with the Fraser Agency said the debacle leaves local consumers who are shopping for policies outside of the workplace with few options.
“There are not a lot of choices this year,” Beck said, adding the same problem applies to individuals who shop for coverage through the marketplace or with local agents. “The problem is the same for everyone in the area, individuals seeking insurance have the option of Blue Cross Blue Shield or First Care, which the hospital is also in limbo of not taking. Scott and White is available in some cases, but nobody (local health care providers) takes it.”
Beck said Fraser Agency offers a short-term temporary policy that gives consumers an option for lowering premiums, but patients with preexisting conditions are not accepted. The policy also doesn’t meet federal insurance requirements, leaving fines and penalties to pay at tax time.
In a troubled economy the penalties are also significant. For tax year 2016, uninsured individuals will be fined 2.5 percent of their total household adjusted gross income, or $695 per adult and $347.50 per child, to a maximum penalty of $2,085.
To avoid penalties and have coverage in place in the case a catastrophic event occurs, Beck suggests that consumers sign up with BCBSTX even if it is out-of-network. She also said consumers should sign up through the Health Insurance Marketplace.
“It offers the same plans and same network, but the premium can be more affordable for those who qualify,” she said.
Beck also said consumers can get added coverage by subscribing to a supplemental policy through companies like Aflac that can help fill coverage gaps and pay expenses not covered by their medical insurance.
Erath County has a fund to help those who cannot afford medical care, and Micki Bell, indigent healthcare administrator for Erath County, said failed negotiations will not impact the service. The indigent healthcare fund is eight percent of the county’s tax levy and serves as a last resort for the “bottom tier,” or patients who have nothing.
Bell said conditions of approval include limited income and resources and patients cannot have access to any insurance – in-network or out-of-network. To qualify, patients must have been previously denied coverage through Medicaid and disability.
For more information, BCBSTX subscribers should call the customer service phone number listed on the back of their insurance card. For information about local hospital care, call Texas Health Stephenville at 254-965-1500.
Consumers can also review information from Texas Health online.