Provided/Jim Olson
Jim Olson receives health care at a Memorial Hermann facility.
Memorial Hermann Health System and Blue Cross Blue Shield of Texas (BCBSTX) have reached a new agreement after months of negotiations, the Houston-based hospital system announced Saturday morning.
The two parties negotiated for more than 8 months, but allowed an April 1 deadline to pass without a new contract. That meant patients with commercial or Blue Advantage Marketplace insurance plans through Blue Cross Blue Shield were considered out-of-network and unable to access in-network services at Memorial Hermann facilities throughout the region, so they were temporarily forced to pay higher medical costs or find new doctors within the BCBSTX network.
The new agreement means those insurance customers will “once again” have in-network access, Memorial Hermann said in a statement to Houston Public Media.
Sign up for the Hello, Houston! daily newsletter to get local reports like this delivered directly to your inbox.
“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 also said in its statement.
BCBSTX, in a statement, confirmed it reached a “mutual agreement that protects our members’ access to quality care at cost-effective prices. ” The insurance company added that the deal is retroactive to April 1.
“Any claims processed as out-of-network on or after April 1 will be reprocessed as in-network,” BCBSTX stated on its website. “You don’t need to take any action. Please be patient as this may take several weeks.”
After the contract expired earlier this month, Memorial Hermann said some Blue Cross Blue Shield customers would continue to receive in-network rates through a “continuity-of-care” program. That included patients who are “pregnant or being treated for a disability, acute condition, or life-threatening illness.”
On its website, Memorial Hermann said BCBSTX customers with questions about their coverage should call the number on the back of their insurance ID cards. The hospital system also said patients who had canceled upcoming appointments could reach out to their health care providers about rescheduling.
Cancer survivor Jim Olson, 57, of Montgomery, said he was scheduling a biopsy for a new tumor his doctors found when the contract ended. He had received cancer treatments at Memorial Hermann for years and hoped to continue his care with the health system.
Olson said a BCBSTX representative told him over the phone he would qualify for the continuity of care and be given an in-network rate for the biopsy, but he described the appeal process as arduous.
“I am grateful they seem to have approved this, but it took several hours of my time and my doctor’s time to appeal it,” Olson said. “Not to mention the unnecessary anxiety.”