The emergency room doctors at Texas Health Presbyterian Hospital Denton are still considered out of network for people with Blue Cross Blue Shield of Texas insurance, though patients still aren’t taking a financial hit.
Texas Medicine Resources, a physicians group that staffs the hospital’s ER and others across the region, could not reach an agreement with BCBS by April 15, so the contract expired. In-person discussions should begin this week or next, said Ralph Baine, president of TMR.
“Unfortunately, we’re not there yet and we’re still talking. I don’t have a projection, to be honest with you,” Baine said. “We’re obviously going to try to keep getting it worked out, and if we can get a fair rate, we’ll definitely sign.”
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. TMR launched www.ertruths.com to answer consumer questions, and BCBS issued a full statement on the website www.standingwithtexas.com when the contract expired in April.
A representative for BCBS did not return multiple requests for comment.
The main point of contention is what the contract is worth, Baine said. Once both parties can agree how much money BCBS will pay TMR for its services, a contract can be signed.
At Texas Health Presbyterian Denton, BCBS still covers all other parts of a hospital stay, from testing and lab work to other labor costs. Only the ER physicians’ care is not in network, which means insurance won’t help pay for this portion of the bill. TMR will continue to absorb the increased cost that was formerly covered by insurance so patients don’t see a difference in their bill, Baine said.
“We’ve kept our promise of keeping the patient out of the middle,” he said.