Can someone explain all that is going down?

My understanding is that BC/BS and S&W could not come to an agreement on fees and coverage and S&W will no longer be in-network as of July 1.

I received seven letters yesterday covering each of my doctors I have seen over the past 20 years saying that they no longer will be associated with the A&M PPO advantage plan and each letter gave a list of the new in-network doctors.

But the letter did state that I could still go to the S&W doctors if they agree to see me as a patient, accept Medicare assignments and will submit claims to the plan.

Does anyone know if their would be an additional cost or will Medicare pick up any changes in costs?

How can a hospital and clinic like S&W not be connected to the A&M plan in a community that has probably more than 30,000 A&M employees and family members?

Also, I have prescriptions I get refills monthly. Although this doesn't affect Express Scripts directly, the prescription comes from S&W doctors so will there be an issue on getting refills after July 1?

Medicare will probably not cover everything if you have a supplement also that should cover it all

happyinBCS said:

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Medicare will probably not cover everything if you have a supplement also that should cover it all

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That's the way it is now already.

The questions are,

Anyone with more knowledge than I have has any idea if the S&W doctors will still accept current patients even if A&M is not connected to S&W with the BCBS plan. And if so, will Medicare and the advantage plan pay for it as it does now if it becomes out of network without having to pay more.

If i do have to change doctors, I assume I will have to get new prescriptions to the pharmacy from the new doctor in order to get refills?

I really don't want to change the four doctors I have seen for the past ten or more years.....if it ain't broken, don't work to fix it.

Both BSW and BCBS are all about their "margins" - both are technically non profits (although BCBS is taxed). They will get a deal done - if not by 7/1 then within a month or two. Your BCBS Medicare Advantage will not pay at BSW during an out of network break. That is what the info they sent you is saying.

befitter said:

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They did this a couple of years ago and finally came to an "agreement". This is all BS and money driven.

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I guess the key right now is to one, not get sick or in an accident for a month or two, and two, make sure you have a few authorized prescription refills to cover a few months.

I know this occured a few years ago, but then I didn't receive letters saying my BSW doctors are no longer in network and suggesting to go to another network doctor.

The A&M System is putting a lot of pressure on both to come to an agreement.

There is less than a 0% chance they've decided to say "screw it" and are no longer working on a new contract.

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I know this occured a few years ago, but then I didn't receive letters saying my BSW doctors are no longer in network and suggesting to go to another network doctor.

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S&W is still in network with BCBS until July 1st.

Is Express Scripts a part of BCBS? Will current prescriptions from S&W doctors not be covered under the current TAMU plan after July1?

From past experience, if they no longer take the insurance, the patient becomes cash pay. Is your BCBS Advantage plan in place of traditional Medicare?

I'm sure the issues is that the Advantage plan's reimbursement rates stink and this is why BSW no longe wishes to do business with them. From my understanding, they will continue to accept the BCBS PPO plans, they just aren't taking the managed Medicare/retirement plans

Will BSW still accept regular Medicare and just not accept Medicare Advantage?

They are 2 different plans with different reimbursement amounts.

Rapier108 said:

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I know this occured a few years ago, but then I didn't receive letters saying my BSW doctors are no longer in network and suggesting to go to another network doctor.

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S&W is still in network with BCBS until July 1st.

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That's what I stated in my original post.

woodiewood said:

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befitter said:

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They did this a couple of years ago and finally came to an "agreement". This is all BS and money driven.

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I guess the key right now is to one, not get sick or in an accident for a month or two, and two, make sure you have a few authorized prescription refills to cover a few months.

I know this occured a few years ago, but then I didn't receive letters saying my BSW doctors are no longer in network and suggesting to go to another network doctor.

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Even if it goes on a few weeks they will "back pay". They send these letters out for CYA....to make sure the customer knows it's not "their fault". I've received a letter from both BCBS and SW.....blaming the other side. It's ridiculous IMO.

befitter said:

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woodiewood said:

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befitter said:

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They did this a couple of years ago and finally came to an "agreement". This is all BS and money driven.

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I guess the key right now is to one, not get sick or in an accident for a month or two, and two, make sure you have a few authorized prescription refills to cover a few months.

I know this occured a few years ago, but then I didn't receive letters saying my BSW doctors are no longer in network and suggesting to go to another network doctor.

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Even if it goes on a few weeks they will "back pay". They send these letters out for CYA....to make sure the customer knows it's not "their fault". I've received a letter from both BCBS and SW.....blaming the other side. It's ridiculous IMO.

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Good. I have never received letters the time in the past that there was negotiations.

Gotta love BC/BS.

ElephantRider said:

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Gotta love BC/BS.

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My late neighbor had S&W insurance and had to sue them to get them to treat M.D. Anderson as in-network when she wanted to be treated there because (big surprise) the S&W hospital in Temple wasn't giving her confidence she was getting the best treatment.

It's not just BC/BS that does this out-of-network stuff.

A&M should choose an insurance that is covered by the local hospital. Same with their dental insurance. Hardly any dentist in town accepts their insurance.

armymom said:

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A&M should choose an insurance that is covered by the local hospital. Same with their dental insurance. Hardly any dentist in town accepts their insurance.

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BSW has handled my A&M insurance for many, many years with no issues. Had no issues with dental either. Have no idea about child coverage.

woodiewood said:

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armymom said:

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A&M should choose an insurance that is covered by the local hospital. Same with their dental insurance. Hardly any dentist in town accepts their insurance.

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BSW has handled my A&M insurance for many, many years with no issues. Had no issues with dental either. Have no idea about child coverage.

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Same. One time an urgent care sent me a large bill but that got resolved. Been using BCBS through TAMU since they stopped carrying S&W insurance in Sept 2009. (I know the year cause I had to switch insurance before my child was born).

This also affects State of Texas employees. I had to move a surgery up to make sure it was covered since the deadline is July 1. I am sure they will come to an agreement, but it may be a month or two after.

The only thing we need like Houston is great hospitals and more doctors.

legalbird said:

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The only thing we need like Houston is great hospitals and more doctors.

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Not gonna happen with great hospitals and doctors just over an hour away. Just not worth the mega bucks it would take.

Has anyone heard any update on the negotiations between BCBS and S/W?

The S&W website looks the exact same as it did before, no updates. I guess no news is good news. Its better than bickering out in public.

https://www.bswhealth.com/patient-tools/registration-and-billing/blue-cross-blue-shield

I found a pretty good article going over the issues with them and several other business disputes affecting medical access in Texas.

Explaining issues impacting Texas health insurance coverage, care | kagstv.com

BSW has postponed the out of network issue with BCBSTX until Oct 1, 2024.

I believe I said in another thread, this is a bunch of posturing to improve one side or the other's position at the bargaining table. BS&W likes money. BCBS likes money.

Hornbeck said:

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I believe I said in another thread, this is a bunch of posturing to improve one side or the other's position at the bargaining table. BS&W likes money. BCBS likes money.

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Agree it is posturing.

However the elderly in our community are freaking out at the letters from both BSW and BCBSTX stating "you will need to get a new doctor or be billed as out of network".

…and they are counting on that. They are counting on the elderly to get on the phone and call the other party ( those crooks at BS&W or those devils at BCBS) to voice their extreme displeasure. Maybe that's why both sent letters?

Negotiations extended to Oct 1. They will come to an agreement.