15 hospitals in the Bryan-based CHI St. Joseph and Houston-based CHI St. Luke health systems may be out of network with Blue Cross and Blue Shield of Texas (BCBSTX) in two months.
This week’s public announcement comes after CHI’s parent company last June issued a termination letter to Blue Cross. The notice included an intent to renegotiate reimbursement payments the insurance company makes to the hospitals. Four months later, a new contract has not been reached. The deadline is December 16.
Both sides say this involves only St. Joseph’s hospitals in Bryan and College Station, health centers in Caldwell, Madisonville and Navasota, and ten locations in the St. Luke’s system. This does not apply to any physician practices.
A statement from St. Joseph’s and St. Luke’s, which are owned by CommonSpirit Health, says in part that “BCBSTX for years has reimbursed CHI St. Luke’s Health (which WTAW News says includes CHI St. Joseph Health) at rates far below those of other similar healthcare providers in the market.”
Quoting part of the BCBSTX statement…”CommonSpirit is demanding unreasonable rate increases. Such rates are not sustainable nor are they a burden our members and customers should have to bear.”
WTAW News asked both sides why June’s termination letter and the intent to renegotiate was not shared with customers until October.
A BCBSTX spokesman tells WTAW News “In June, we were hopeful that we would make progress toward renewal with CommonSpirit Health after they termed us. As we got closer to the expiration date (Dec. 16) and it looked more likely that we could potentially have a disruption, it’s important that our new members know especially as they start to make healthcare decisions for open enrollment. Moreover, certain product require different notification times. For instance, for HMO plans it’s 30 days…for federal employee plans it’s 90. As well, most contracts between health insurers and providers have a 60-day termination notice where either party is required to give a heads up to the other if they make the decision to issue a termination notice. That does not mean that the two parties can’t still negotiate (as is the case here). If they don’t come to an agreement, then the provider or the health insurer will no longer be in network.”
A St. Luke’s spokeswoman also speaking on behalf of St. Joseph’s tells WTAW News “we are regretful that our patients and their employers are caught in this negotiation. Our intention was to complete this negotiation without having to alarm our community. We hope that BCBSTX will recognize the critical importance of providing continuous, quality care to our communities and therefore, agree to a reasonable reimbursement rate. The hospital agreements with BCBSTX are scheduled to terminate on 12/16/2020. Until this date, or until further notification, services provided to BCBSTX members will continue without disruption. If an agreement cannot be reached, CHI St. Luke’s Health will send frequent and comprehensive communications to patients and update our website with details about continued care.”
And a WTAW listener who is a BCBSTX customer shared this response from the company’s Facebook page: “If we can’t agree to fair terms with CommonSpirit Health, we’ll be here to make your move to other doctors, hospitals, and surgery centers as seamless as possible. We’ve contacted other in-network hospitals, and they’ve assured us that they can and will welcome you if CommonSpirit Health leaves our network.”
Addition information released by CHI St. Luke’s Health, which includes CHI St. Joseph Health:
On June 17, 2020, after months of discussions and negotiations, CHI St. Luke’s Health, including Baylor St. Luke’s Medical Center, issued a written 180-day Notice of Termination with Intent to Renegotiate to Blue Cross Blue Shield of Texas (BCBSTX). CHI St. Luke’s doctors, nurses and staff work tirelessly to care for our communities. Unfortunately, BCBSTX for years has reimbursed CHI St. Luke’s Health at rates far below those of other similar healthcare providers in the market.
CHI St. Luke’s Health comprises 16 hospitals located in Houston, Bryan/College Station, and East Texas, including the renowned Baylor St. Luke’s Medical Center (BSLMC). BSLMC is an academic health center providing quaternary care. We are a non-profit health system serving 75,000 people in an inpatient setting and 955,000 people via outpatient visits each year. During our fiscal year ended June 2019, we provided $115 million of charity care to the community.
The cutting edge cancer, cardiovascular, diabetes, transplant and surgical care provided at CHI St. Luke’s Health and Baylor St. Luke’s Medical Center, amongst other hospitals, are in jeopardy without reasonable reimbursement rates from BCBSTX. We cannot continue to help BCBSTX achieve its multi-billion dollar annual, at the expense of our ability to provide quality care for our communities.
The following is a statement from Dr. T. Doug Lawson, CEO of CHI St. Luke’s Health, regarding the 180-day Notice and ongoing negotiations:
“It is unfortunate that Blue Cross Blue Shield of Texas has not been more willing to reimburse at levels that enable us to provide essential services. We were forced to issue the notice in an effort to motivate Blue Cross Blue Shield of Texas to agree to rates that enable us to preserve access and care to critical health services for the patients we serve throughout our region, especially as our community reels from the impact of COVID-19.
“Our sincerest hope – and our belief – is that we can work together to achieve a reasonable agreement to ensure access to essential services are available for patients and employers across the region.”
If CHI St. Luke’s is unable to reach a mutual agreement with BCBSTX by December 16, 2020, the termination will take effect. During this period, CHI St. Luke’s Health remains in-network with BCBSTX.
Additional information released by Blue Cross-Blue Shield of Texas:
On June 19, 2020, we received a termination notice from CommonSpirit Health, notifying us of its intent to leave our networks on Dec. 16, 2020. We have an obligation to do what is best for our members and customers and we hope we can reach a mutually beneficial agreement.
In terminating our contracts, CommonSpirit is not honoring agreements that kept its hospitals in our networks through 2021. Instead, we are forced to renegotiate and divert our attention from the global pandemic at hand.
CommonSpirit is demanding unreasonable rate increases. Such rates are not sustainable nor are they a burden our members and customers should have to bear. Their demands would drive up the cost of health care not only in the Houston area but Bryan-College Station, Lufkin and the rest of the southeast Texas communities we serve.
This comes during a public health emergency when businesses have suffered financial loses and many of our customers around the state have been forced to lay off thousands of employees.
We think the demands are unreasonable and will do all we can to represent our members and customers in this negotiation. We want fair contracts that balance the need of our members and providers.
As a customer-owned health insurance industry leader in Texas for nearly 90 years, we negotiate with providers to find the best solutions for our members. We advocate for high-quality, cost-effective health care. It is a responsibility we take very seriously.
If CommonSpirit chooses to leave our networks, we will do everything we can to help members move their care to quality, cost effective, convenient in-network hospitals and doctors.
