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

22,330 Views | 145 Replies | Last: 3 yr ago by dubi
DR. WONG
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The TAMUS Benefits Administration Office does not currently have a director. They appear to be rudderless.
gettingitdone
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I am not seeing that stated above in the email from TAMU. Am I missing somthing?
chigger
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AG
misread
dubi
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gettingitdone said:

I am not seeing that stated above in the email from TAMU. Am I missing somthing?
It was stated by Kiddoc on page 2.

Quote:

Mark Riggins has sent a letter on behalf of the primary care providers to BCBS that will allow the SJMG PCPs to continue to stay in-network for the insurance. Consequently, patients will be able to continue seeing their PCPs in the clinics without interruption. The specialists will also be able to see patients in the outpatient setting and perform any in-office procedures, and some of our specialists have privileges in outside hospitals as well. Consequently, the specialists will continue to take referrals as previously.

Two of the clinic/facility services that will be affected are labs and imaging. For labs, based on patient insurance, there are options to send patients to CPL, Quest, and Labcorp. Because of the eCW interface with CPL, it is highly encouraged to send patients to CPL so we can get discrete data back into the EHR that will qualify for our quality metrics and be the least disruptive to our regular clinic workflow. We are working through the processes of imaging at this point and will give you more details in the coming week.
BaitShack
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dubi said:

Quote:

I dont know if it still is, but Caprock was also in network (at least their urgent care was, I assume their ER is too)
A few months ago Caprock had a few commercials advertising their ER was in network.

Caprock and PC are fine for the little stuff, but go to St Joe or S&W if you are having a heart attack or stroke.
Were those the commercials that said "You won't pay more at Caprock than you will anywhere else!"
isitjustme
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AggieBarstool said:

agrab86 said:


Looks like neither BCBS or CHI care about most of our health, which isn't surprising. And if TAMUS doesn't step in and force a local solution, then they don't care about their employees.
If you ever thought it was about care and not about money...
I know, seems like a rookie mistake. I at least thought A&M might care, but I was being optimistic.
ZachTheGoodAg
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Regarding TAMU stepping in, don't forget that this whole thing is not between our CHI St Joseph Hospital locally and BCBS....it's between the parent organization of our local hospital and BCBS. From all I hear, the real issue is with CHI St Luke's and their associated hospitals in Houston. But since our local hospital falls under the same group, we get affected. The local hospital here can only do so much, since they are ultimately at the mercy of the bigger organization. I think someone put it well that we are 'collateral damage' in the bigger picture.

That being said, so far I feel like TAMU HR has been less than helpful in being more specific about where you CAN go right now locally and be in-network, as well as answering some of the obvious questions about to what extent this applies the hospital vs providers. I see someone posted above they are without a head right now, which could explain some of that.

Hopefully, the parties will ultimately find a better compromise because right now it sure isn't great situation for those of us with BCBS locally.


ZTGA
gettingitdone
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Thank you!! This entire mess will determine where my husband can go. I have a different insurance so I am ok.
Stucco
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It seems like this is not just BCBS-TX. I have Horizon BCBS-NJ, and I am impacted by this just as if I had BCBS-TX.

EBrazosAg
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It's definitely not just BCBS TX. It has to do with which BCBS association it is and if the out of state accesses docs here with "renting" the BCBS TX network. It's very complicated and obscure with BCBS.
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KidDoc
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Note that if you have a true emergency and need to stay in a hospital BCBS is forced to cover it via EMTALA. So if you have a car wreck, stroke, heart attack, need to be hospitalized for COVID and are admitted through the ER it will be covered.

If you need a non emergent procedure or hospital stay it will not be covered at this time.
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DR. WONG
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The TAMUS Health Care Plan is self-funded. BCBSTX is the third party administrator. TAMUS is the fiduciary and the Benefits Administration director plays that role. They have extraordinary responsibility and authority in administering the plan. They are required by federal law to make decisions in the best interest of its members and can do so through extracontractual processes if need be.

The parent company of BCBSTX is Health Care Service Corporation (HCSC). Elaine Mendoza, who is the Chair of the TAMUS Board of Regents also sits on the Board of Directors for HCSC.

The TAMU Health Science Center has agreements in place with CHI for both its academic programs and to create the Brazos Valley Network. Currently, there is no hospital in the Brazos Valley Network and the HSC agreement precludes any opportunity to add Baylor Scott & White or The Physicians Centre.

dubi
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Quote:

The TAMU Health Science Center has agreements in place with CHI for both its academic programs and to create the Brazos Valley Network. Currently, there is no hospital in the Brazos Valley Network and the HSC agreement precludes any opportunity to add Baylor Scott & White or The Physicians Centre.
Is the "Brazos Valley Network" the reason we have lower copays at CHI?

Can you give more details about what that means to TAMUS BCBSTX customers?
EBrazosAg
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It means they can't add a lower copay for other facilities. Technically non BV Network facilities have "normal" copay and co insurance. BV Network have a "discounted" copay and co insurance. Semantics I know .....
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gettingitdone
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I wondered about this as well. I think almost all BCBS insurance cards state on the back, "File all claims through your local BCBS Company". This in essence means all claims are filed through BCBSTX for processing. Not sure how all of it works on the back in but it will be interesting to see. I have a family member whos husband has covid. They have a private policy with BCBSTX, but it is an HMO plan. She was told that SW doesn't not accept HMO plans, and now that St. Joseph isn't taking BCBS either, she is worried about what to do.
befitter
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gettingitdone said:

I wondered about this as well. I think almost all BCBS insurance cards state on the back, "File all claims through your local BCBS Company". This in essence means all claims are filed through BCBSTX for processing. Not sure how all of it works on the back in but it will be interesting to see. I have a family member whos husband has covid. They have a private policy with BCBSTX, but it is an HMO plan. She was told that SW doesn't not accept HMO plans, and now that St. Joseph isn't taking BCBS either, she is worried about what to do.
I have the HMO plan and SW is in network. As WAS St. Joseph until this mess.
MisterShipWreck
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gettingitdone said:

I wondered about this as well. I think almost all BCBS insurance cards state on the back, "File all claims through your local BCBS Company". This in essence means all claims are filed through BCBSTX for processing. Not sure how all of it works on the back in but it will be interesting to see. I have a family member whos husband has covid. They have a private policy with BCBSTX, but it is an HMO plan. She was told that SW doesn't not accept HMO plans, and now that St. Joseph isn't taking BCBS either, she is worried about what to do.
I have the Texas Health Select HMO from BCBS. I see a couple of S&W doctors every year, and they take my BCBS insurance.
dubi
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befitter said:

gettingitdone said:

I wondered about this as well. I think almost all BCBS insurance cards state on the back, "File all claims through your local BCBS Company". This in essence means all claims are filed through BCBSTX for processing. Not sure how all of it works on the back in but it will be interesting to see. I have a family member whos husband has covid. They have a private policy with BCBSTX, but it is an HMO plan. She was told that SW doesn't not accept HMO plans, and now that St. Joseph isn't taking BCBS either, she is worried about what to do.
I have the HMO plan and SW is in network. As WAS St. Joseph until this mess.
Read above KidDoc post. Emergency care for Covid, heart attack, stroke would be covered.

Quote:

Note that if you have a true emergency and need to stay in a hospital BCBS is forced to cover it via EMTALA. So if you have a car wreck, stroke, heart attack, need to be hospitalized for COVID and are admitted through the ER it will be covered.

If you need a non emergent procedure or hospital stay it will not be covered at this time.
befitter
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dubi said:

befitter said:

gettingitdone said:

I wondered about this as well. I think almost all BCBS insurance cards state on the back, "File all claims through your local BCBS Company". This in essence means all claims are filed through BCBSTX for processing. Not sure how all of it works on the back in but it will be interesting to see. I have a family member whos husband has covid. They have a private policy with BCBSTX, but it is an HMO plan. She was told that SW doesn't not accept HMO plans, and now that St. Joseph isn't taking BCBS either, she is worried about what to do.
I have the HMO plan and SW is in network. As WAS St. Joseph until this mess.
Read above KidDoc post. Emergency care for Covid, heart attack, stroke would be covered.

Quote:

Note that if you have a true emergency and need to stay in a hospital BCBS is forced to cover it via EMTALA. So if you have a car wreck, stroke, heart attack, need to be hospitalized for COVID and are admitted through the ER it will be covered.

If you need a non emergent procedure or hospital stay it will not be covered at this time.

Yes, I understand that ER care is covered.
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dubi
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Slocum on a mobile said:

I'm betting that once St. Joe's sees a significant drop at both their hospitals, that they will begin negotiations anew....


70% of CHI St Joseph's patients were BCBS.

It is painful made worse by the fact the Governor has once again cancelled elective surgery.
EBrazosAg
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That's not correct.
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dubi
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EBrazosAg said:

That's not correct.


Which part?
EBrazosAg
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The whole thing. Otherwise I would have specified...
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histag10
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Didnt KidDoc or someone else say these negotiations had little to do with BCS and St. Josephs, and more to do with the Houston CHI market?
doubledog
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histag10 said:

Didnt KidDoc or someone else say these negotiations had little to do with BCS and St. Josephs, and more to do with the Houston CHI market?
That is correct. It is all about St. Luke CHI Houston (and its competition).
trouble
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Elective surgeries & procedures are being cancelled thanks to the executive order and the random 15% rule.
dubi
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trouble said:

Elective surgeries & procedures are being cancelled thanks to the executive order and the random 15% rule.
EBrazosAg seems to know more than the actual OR and recovery room nurses who suddenly can't work. He said above that I was wrong about this.
EBrazosAg
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Elective surgeries in general have not been canceled .... at least not as of right now. In fact, some BCBS elective cases are occurring through their Continuity of Care provisions in contracts. I suspect that will eventually go to near zero. But it hasn't yet.

BCBS is not 70% of SJ business. No one payer would come close to that level.

So as I said earlier, both of your statements were incorrect. Don't put my words about that into another members post. I didn't comment on theirs.
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gettingitdone
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You do realize that it isn't St. Joseph doing this? It is the parent company Common Spirit Health which owns many many hospitals. The local hospitals have no say.
EBrazosAg
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Actually BSW is not laughing and a part of their capacity constraints currently are due to shift in patients over this issue. So it's not good - currently - for either local hospital.
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CCMD
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St. Joseph back in network with BCBS as of yesterday. See below copy of e-mail.

January 8, 2021
Good evening Texas Division Colleagues,
As you're all aware, St. Luke's Health's previous contract with Blue Cross Blue Shield of Texas (BCBSTX) terminated on December 16, 2020. I am pleased to inform you that we have reached an agreement with BCBSTX on a new contract, ensuring coverage for 65,000 BCBSTX patients who choose to receive their health care at a St. Luke's Health or St. Joseph Health hospital.
As of January 8, 2021, all BCBSTX policy holders will be in-network at all St. Luke's Health facilities, including St. Joseph Health.
This new contract will help St. Luke's Health, as well as St. Joseph Health, preserve the essential, high-quality care our dedicated healthcare workers provide at each of our hospitals, while enabling us to continue to invest in each of you, our facilities and new technology. Especially during the pandemic, the ability to choose and have access to the value-driven care we supply is of the utmost importance to us, and we are committed to providing just that.
I want to be sure to thank you for your continued support and commitment to St. Luke's and St. Joseph Health and our patients during this time. This period of termination has been admittedly difficult, and your hard work and dedication to the St. Luke's Health ministry has not gone unnoticed.
During the termination period, we have been working to assist qualifying patients with access to continuity of care. This issue remains a top priority to us, and as of January 8, 2021, St. Luke's Health and BCBSTX have agreed that BCBSTX patients who had care provided by St. Luke's Health, including St. Joseph Health, on or after December 17, 2020, will have access to in-network benefits. As such, it is absolutely essential that you quickly work to coordinate any ongoing care with your patients and get them rescheduled into a St. Luke's or St. Joseph hospital. Our hospitals are ready and able to accept patients. As part of the agreement, we will also no longer be required to stabilize and transfer patients. BCBSTX patients who present to one of our hospitals will be able to receive full care at our facilities.
This current surge of the coronavirus is as serious as the major outbreaks this summer and I and the leadership team realize how demanding and stressful it is for all of you. Our patients and community need you and our healthcare ministry now more than ever.
I am so grateful for your dedication to our healthcare ministry during these unprecedented times. I hope the good news about our Blue Cross Blue Shield contract brightens your day.
Thank you,
(from Doug Lawson - CEO CHI St.Lukes)
dubi
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Thank you!
KidDoc
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Hurray!
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