The health system had been out-of-network for Blue Cross Blue Shield commercial and Blue Advantage Marketplace plans since the sides failed to agree to a new contract before an April 1 deadline. Without a contract, thousands of Houston patients could have been forced to pay out of pocket to keep their current providers or switch to new doctors for treatment.
“Throughout these negotiations, our priority has been to secure a fair agreement that supports the long-term sustainability of the high-quality care we provide and recognizes the value of our physician network,” Memorial Hermann said in a statement Saturday.
Memorial Hermann did not immediately respond to a question about whether the new contract would affect medical bills for any patients with Blue Cross Blue Shield who have been out-of-network since April 1. Patients with questions about coverage should call the phone number on the back of their insurance cards, the health system said on its website.
The health system and the insurer said previously that certain Blue Cross Blue Shield members – including those being treated for acute conditions, life-threatening illnesses, disabilities or pregnancies — could still qualify for continuity of care, meaning they could still be treated at Memorial Hermann for in-network rates.
Patients who canceled appointments since April 1 should call their care team to reschedule, the health system said.
The agreement announced early Saturday ends the impasse between the largest health care provider in the Houston area and the biggest insurer in Texas. Both the health system and the insurer told the Houston Chronicle this week that they were still committed to reaching a deal.
Blue Cross Blue Shield accounted for more than 26% of the state’s health and accident insurance market share as of 2024, nearly three times more than the second-largest insurer, UnitedHealthcare, according to Texas Department of Insurance data.
Memorial Hermann has more than 1.8 million patient visits annually across 14 hospitals and hundreds of doctors’ offices and clinics.
Hospitals and insurers routinely negotiate contracts that set reimbursement rates for medical services, but the sides typically come to an agreement before the older contract expires. Such talks have become more contentious in recent years, though, due to trends such as rising health care costs and consolidation in the industry, according to NPR.