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Blue Cross/Blue Shield Texas - St. Joseph CHI = Ending Insurance Coverage

4,023 Views | 42 Replies | Last: 6 days ago by Slocum on a mobile
CatPit1
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Howdy Folks,

I received a letter from Blue Cross Blue Shield of Texas, which told me that CHI St. Joseph has elected to end their relationship with BCBSTX in mid-December. One would gather that BCBSTX may not be paying enough to CHI and this may be a bit of posturing, but my family has a 25+ year relationship with both BCBSTX and CHI. If we need to change doctors or health insurance carriers, we need to know that ASAP.

This is a big deal for many of us. Does anyone have any updated information on the status of negotiations between CHI and BCBSTX?

Thanks,

James
Justin2010
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AG
Last I heard was that people were guessing this was a game of chicken - negotiating tactic.
1.618
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I think it is negotiating with clients/patients stuck in the middle.

Perhaps the current reimbursement rates are not as high as CHI St Joseph would like/needs. If they don't come to an agreement, is zero going to be a better option for CHI St. Joseph? I guess that some would still go to CHI and pay out of network rates but would that reimbursement plus whatever they collect from the patient make up for the patients that would stay in network with Scott & White? I doubt it.

If an agreement is not made before the expiration of the contract period, my bet is that an agreement is made within the following 30 days. CHI won't want the patients to establish firm relationships with non CHI doctors as they might not get those patients back when an agreement is reached.

No inside information here. I've just seen this dance done before and it often comes down to the very last minute. It is unfortunate for the patients.
chickencoupe16
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1.618 said:

I think it is negotiating with clients/patients stuck in the middle.

Perhaps the current reimbursement rates are not as high as CHI St Joseph would like/needs. If they don't come to an agreement, is zero going to be a better option for CHI St. Joseph? I guess that some would still go to CHI and pay out of network rates but would that reimbursement plus whatever they collect from the patient make up for the patients that would stay in network with Scott & White? I doubt it.

If an agreement is not made before the expiration of the contract period, my bet is that an agreement is made within the following 30 days. CHI won't want the patients to establish firm relationships with non CHI doctors as they might not get those patients back when an agreement is reached.

No inside information here. I've just seen this dance done before and it often comes down to the very last minute. It is unfortunate for the patients.


This. Especially with the pretty new S&W hospital looking and feeling 10 times nicer than St. Joe's or The Med. It wasn't part of our decision, but I know at least 2 mothers that picked an OB at S&W because of the fact that it's new. I don't think that should carry much weight, if at all, but it does with some.
bobinator
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The part that makes it hard to figure out how they didn't settle all of this already is how much A&M is partnering with CHI.

Can't imagine that they're going to have A&M logos all over all their buildings in town but not find a way to work with the insurance provider that everyone that works at A&M has.
histag10
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A&M has a separate network with St. Joes, so im wondering if that is how they will keep it. Also, A&M med school partners with St. Joes as a teaching hospital
MiMi
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S
Quote:

A&M has a separate network with St. Joes, so im wondering if that is how they will keep it.
It is a separate network but employees/retirees still use BCBS for our insurance. My understanding is that this network/partnership has discount pricing and lower copays if we choose a CHI St. Joe provider.
bobinator
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Yeah it's what they call the 'Brazos Valley Network' which can be quite a bit cheaper depending on what you're doing.

I know that it's not a complete partnership in all things, I'm just saying that to me it would be odd for A&M's logo to be all over CHI-St. Joseph buildings all over town but for A&M's insurance provider not to work with them.
BQ_90
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I e got BCBS and it's open season, wonder if I need to change.

All my dr are part of CHI SJ
LOYAL AG
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TRS just switched back to BCBS with this school year. That's CSISD. IIRX Bryan ISD is self insured and BCBS is the administrator for that plan.

I'll be shocked if this doesn't get resolved. Too many people at risk.
UhOhNoAgTag
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Hmmmm.
texagdoc
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I expect that a deal will be made soon. If not, CHI will protect its patients from high out of network rates. I wouldn't be looking for a new doctor at this point.
gettingitdone
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The fact that TAMU partners up with CHI for teaching, etc, has nothing to do with BCBS. From all appearances, the issue is with BCBS. Maybe TAMU should use their influence to encourage bcbs to settle.
MisterShipWreck
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Is it just the hospitals or ALL doctor's that have St Joseph on their doors?

I think it is just the hospitals themselves, but who knows...

I guess I will have to see if S&W and the Physician Center ER is on the approved list for BC/BS...
bobinator
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I know, but it would still be kind of weird right?
gettingitdone
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All St. Joseph(hired) providers would be included along with all St. Joseph facilities. Keep in mind, all insurance are required to pay ER's at in network rates regardless of the facility. Now if after being evaluated in the hospital, it is determined that the patient needs to be admitted, the patient will be transferred to an in network provider.
Should the patient not be stable for transfer, some insurance will give an authorization for the patient to stay.
one MEEN Ag
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I don't see how St. Joseph wins here. If BCBS takes their clients elsewhere, there isn't a large substitutional group to replace that lost income to St. Joseph. On the BCBS side, the only thing they have to do is withstand complaints, it doesn't effect their bottom line. There might be some ill will when BCBS renews their contract, but it would just be considered a cost savings - looking out for A&M. So no-one at BCBS negotiating table is going to really fault them for doing their job. I assume A&M is self insured and BCBS is just the policy driver/negotiator.

St. Joe plays hardball and the patients in the middle just go elsewhere in network, never to return.

I expect 2 - 3 extensions to give more runway on negotiations.

MisterShipWreck
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gettingitdone said:

All St. Joseph(hired) providers would be included along with all St. Joseph facilities.
That sucks.

My insurance switched from United to BC/BS a few years ago - and I had to find a new primary doctor. My old primary doc was in St Joseph, but she would not take BC/BS. So, I got another primary doctor... Who happens to be in St Joseph again....

This will suck if I have to change again...

So many of the local doctors are in the St Joseph network now... More and more of them have been putting that logo on the door.. Even ones I have seen for years...
gettingitdone
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It could mean that TAMU doesn't go with BCBS next benefit season. It actually can mean that BCBS ends up having to do pay network rates for non network providers because patients can't be seen or cared for in a timely manner. BCBS can't force patients to be seen out of town.
histag10
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gettingitdone said:

It could mean that TAMU doesn't go with BCBS next benefit season. It actually can mean that BCBS ends up having to do pay network rates for non network providers because patients can't be seen or cared for in a timely manner. BCBS can't force patients to be seen out of town.


Scott & White is still in town, and is in network for BCBS. Patients wont have to leave town to be seen by any doctor that they werent already having to leave town to see (pediatric development specialists being one example)
Slocum on a mobile
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Glad I have out of state BCBS. Upside of the company doing well, I pay $0 this year...
MisterShipWreck
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histag10 said:

gettingitdone said:

It could mean that TAMU doesn't go with BCBS next benefit season. It actually can mean that BCBS ends up having to do pay network rates for non network providers because patients can't be seen or cared for in a timely manner. BCBS can't force patients to be seen out of town.


Scott & White is still in town, and is in network for BCBS. Patients wont have to leave town to be seen by any doctor that they werent already having to leave town to see (pediatric development specialists being one example)
I have BC/BS, but I see two S&W doctors because they are doctors with limited numbers here. A neurologist and a dermatologist.

Last time I checked, the dermatologist had a 10 month wait at S&W, if you called today for an apt. I had to wait 6 months to get into the S&W neurologist. I really like both doctors, but that kind of wait is unacceptable. How long do you think the wait will be after this happens?
EBrazosAg
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Policy driver/negotiator - proper term is TPA - 3rd party administrator. BCBS doesn't really do much with policy or negotiation. They kinda just set the rate. Therefore the issue .....
EBrazosAg
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Neurologist- at least good ones - are in short supply for a decade or more. Dermatologist - still a speciality where the hard working ones can kill it as private practice docs. So the S&W of the world struggle to hire.
lockett93
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Slocum on a mobile said:

Glad I have out of state BCBS. Upside of the company doing well, I pay $0 this year...


What do you mean by this? What is out a of state BCBS have to do with it? I have Anthem coverage from my company out of Virginia that uses BCBS in Texas so I'm curious if that is somehow beneficial for me
Jason86
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lockett93 said:

Slocum on a mobile said:

Glad I have out of state BCBS. Upside of the company doing well, I pay $0 this year...


What do you mean by this? What is out a of state BCBS have to do with it? I have Anthem coverage from my company out of Virginia that uses BCBS in Texas so I'm curious if that is somehow beneficial for me
BCBS of another state may as well be another insurance company entirely. Each individual carrier (BCBS of Texas vs BCBS of Illinois) has their own contracts with providers. While BCBS of Texas may be shortchanging CHI, BCBS of Illinois may be paying them 33% more to provide the same service.
bushytailed
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Jason86 said:

lockett93 said:

Slocum on a mobile said:

Glad I have out of state BCBS. Upside of the company doing well, I pay $0 this year...


What do you mean by this? What is out a of state BCBS have to do with it? I have Anthem coverage from my company out of Virginia that uses BCBS in Texas so I'm curious if that is somehow beneficial for me
BCBS of another state may as well be another insurance company entirely. Each individual carrier (BCBS of Texas vs BCBS of Illinois) has their own contracts with providers. While BCBS of Texas may be shortchanging CHI, BCBS of Illinois may be paying them 33% more to provide the same service.
Yeah, a friend of mine has BCBS-TX while her husband has BCBS-IL. His insurance isn't affected by this drama between CHI and BCBS-TX.
histag10
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We use a neuro out of Temple with BSW for my husband, and I use Brazos Valley Dermatology. They can have longer waits for initial visit, but so does pretty much every dermatologist in town. I think there is one private practice that can get you in fairly quickly, but i forget which it is.

S&W can have longer waits on some things because the specialists are in Temple, and only come to BCS on certain days.
histag10
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My husbands old company had BCBS-IL. I really liked them compared to BCBS-TX.
gettingitdone
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As of at least a year ago or so, all BCBS claims file through BCBS of TX regardless of the issuing state.
MisterShipWreck
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I checked with my doctor. Sure enough... It is every St Joseph clinic, not just the hospital.

That really sucks because St Joseph has partnered with so many doctors here... Ones I have seen for years have slowly added St Joseph to their front door..
EBrazosAg
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Partnered = employed. No slowly to it. One day they are independent- next day not.
EBrazosAg
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That is not correct. They are each different companies ... back East a bunch of the Blues operate under the Anthem moniker. This is BCBS tx only contract issue . Not Mississippi, DC, Ohio or any other place.
MisterShipWreck
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EBrazosAg said:

Partnered = employed. No slowly to it. One day they are independent- next day not.
That is kinda what I figured, but I was not sure.

Interesting why doctors who own their own clinic decided to do that. I guess they have St Joseph handle the billing, and there must be other perks for them to change their independence.
Slocum on a mobile
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lockett93 said:

Slocum on a mobile said:

Glad I have out of state BCBS. Upside of the company doing well, I pay $0 this year...


What do you mean by this? What is out a of state BCBS have to do with it? I have Anthem coverage from my company out of Virginia that uses BCBS in Texas so I'm curious if that is somehow beneficial for me


I have BCBS Anthem of California. Which is Blue Shield of CA.
Not affected by the St. Joe's thing. Wife manages a doctors office. She asked.
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