Patients and their families are feeling the strain due to a lack of consensus between insurance companies and hospital networks.
HOUSTON — Patient advocates are labeling the negotiation breakdown between Memorial Hermann Hospital System and Blue Cross Blue Shield of Texas as chaotic.
Those classified as out-of-network are already experiencing difficulties.
“I had no idea all these feelings would come out, but when it’s about your kids, it’s like a mama bear instinct kicks in, and I’ll fight as long as I can,” shared Shelly Logan, a Blue Cross Blue Shield member.
Logan’s son, Ryan, has been in the intensive care unit of Memorial Hermann for several months due to neurological issues, stemming from a stroke he had a decade ago.
“He’s relearning how to walk, talk, and eat, getting back to daily activities,” Logan noted. “This situation has certainly added stress to an already frightening and traumatic experience.”
The family is currently receiving care at Memorial Hermann, which is out-of-network for Blue Cross Blue Shield of Texas since the two parties couldn’t reach a contract.
“I was overwhelmed and thought, ‘Oh my God, what does that mean?'” she recalled.
This issue is particularly impactful as Memorial Hermann is one of only two trauma hospitals in the area, according to Bonnie Thielen, a certified patient advocate.
“It’s the hospital where Life Flight goes; it’s the place you want to be if you’re in a serious accident,” she emphasized.
Thielen explained that the negotiations seem to stem from rising premiums for those under the Affordable Care Act, along with governmental limitations on Medicaid spending, which might be straining the hospital’s finances.
“You hope for a resolution, but it feels like a tug-of-war,” Thielen remarked.
Families and patients needing ongoing healthcare, like Ryan, are encouraged to contact Blue Cross Blue Shield to look into “continuation of care” options. While initial costs might be higher, being proactive could lead to some relief.
“If he can fight daily to live, I can fight for him,” Logan stated.
Though an agreement had eluded Memorial Hermann and Blue Cross Blue Shield of Texas in 2022, they managed to resolve issues fairly quickly. Now, patients are hoping for alternative solutions.
What patients can and should know
Negotiations between Blue Cross Blue Shield of Texas and Memorial Hermann have hit a standstill, leaving numerous patients, particularly those in treatment or with unexpected medical needs, facing uncertainty.
Mistie Hinote from the Texas Department of Insurance (TDI) advises that the key step now is communication. Patients with upcoming appointments should reach out to their physicians to prompt them to request Blue Cross Blue Shield for continued treatment. Staying in touch with your care team is vital while awaiting a possible agreement.
In case of emergencies, there’s some reassurance: Texas law safeguards patients in need of urgent care. If an emergency arises, individuals should go to the closest emergency room, regardless of network status. Patients are shielded from unexpected out-of-network charges for emergency services.
The Texas Department of Insurance has multiple enforcement options against insurers who don’t comply with regulations, including fines and cease-and-desist orders. Regulators lean on consumers to report issues. If patients face any problems, such as insurance denial or billing issues, they can file a complaint through the agency’s online platform or call the Consumer Help Line at 1-800-252-3439.
