Texas Health Presbyterian ER

Patients visit the emergency room at Texas Health Presbyterian Hospital Denton on Wednesday.

Contract negotiations between Blue Cross Blue Shield of Texas and Texas Medicine Resources, a physicians group that staffs some regional emergency rooms, have fallen apart.

TMR is contracted with Texas Health Presbyterian Hospital Denton to provide doctors for the emergency room there and at 13 other Texas Health Resource hospitals in North Texas. Now, these doctors are no longer in the Blue Cross Blue Shield of Texas network.

Representatives for BCBS and TMR had mixed messages for how this will impact consumers since the change was made effective April 15.

“This means TMR physicians are no longer a part of the BCBSTX network, and puts our members at risk for a surprise bill if they receive care in a THR emergency room,” said James T. Campbell, senior manager of communications at BCBS.

Ralph Baine, president of Texas Medicine Resources, said his company’s problem is not with the patients but with BCBS, so the out-of-network costs will not be billed to emergency room patients. For now, the company will bill insurance as usual, then have patients pay their usual copay or deductible — the same as if it were for in-network care, Baine said.

“We’re not going to balance bills above that copay or deductible,” Baine said. “Our issue is with Blue Cross, not patients.”

TMR has staffed the emergency room doctors at Presbyterian for about 10 years, Baine said. Aside from the emergency room doctors, everything else at Presbyterian is considered in-network for BCBS emergency room patients, from the cost to run tests and lab work to the cost of facilities.

Both TMR and BCBS agree that the negotiations are separate from Texas Health Resources, and both have ongoing contracts with THR hospitals.

Now, the two companies have launched websites about the failure to reach a contract agreement. TMR launched www.ertruths.com to answer consumer questions, and BCBS has issued a full statement on the website www.standingwithtexas.com. TMR says it asked for a rate increase for the first time in 10 years, and BCBS says the increase is too expensive and would nearly double the current rate BCBS pays TMR.

Other urgent care and emergency care providers in Denton are considered fully in-network for Blue Cross Blue Shield customers. This includes Medical City Denton, all local CareNow locations and Code 3 Urgent Care in Denton.

JENNA DUNCAN can be reached at 940-566-6889 and via Twitter at @jennafduncan.

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