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Contract Dispute: Southwestern Health Resources May Be Out of the Blue Cross Blue Shield of Texas Network in October

The two sides have been negotiating since July 2021 but have yet to reach an agreement.
Courtesy: iStock

Southwestern Health Resources and Blue Cross Blue Shield of Texas have found themselves in yet another contract dispute. If the two can’t resolve the conflict before October 4, SWHR physicians may be out of network for most of BCBSTX’s plans.

This isn’t the first time this sort of thing has happened. In 2018, Texas Health Resources and Blue Cross were caught up in another impasse, with Texas Health saying BCBSTX’s “inaccurate and misleading claims are polarizing and distracting.” BCBSTX said negotiations were stuck on what they classified as $1 billion in increased payments over the course of the four-year contract. In 2016, another contract dispute went right up until days before it was set to expire at the end of that year. In both cases, the two organizations reached a new contract before the providers went out of network.

Southwestern Health Resources is an integrated network of providers between UT Southwestern and Texas Health Resources. It consists of 29 hospital locations and more than 5,500 physicians and other clinicians. Blue Cross Blue Shield of Texas is the state’s largest health insurer, covering more than six million Texans. Its network includes 80,000 physicians and 500 hospitals.

SWHR has been negotiating with Blue Cross since July 2021, intending to reach an agreement by March this year. The current contract is set to end in October. If the two sides don’t come to an agreement, SWHR facilities would be out of network for several BCBSTX plans, including Medicaid and Medicare Advantage plans.

BCBSTX says that SWHR has submitted a notice of termination to BCBSTX. In December, the Blue Advantage HMO plan physicians would be out of network without an agreement.

website set up by SWHR to address questions about the contract dispute. “You may have received a message from BCBSTX saying we may soon be out of network,” it says. “We understand your concern. We look forward to keeping you updated as we continue our dialogue with BCBSTX. We remain committed to reaching that agreement as quickly as possible and will keep stakeholders updated as we work together to come to a resolution.”

The website says the organization is still working to resolve the conflict and says that SWHR patients with BCBSTX health plans receiving ongoing care may be eligible for continuity of care benefits, where temporary in-network access is extended to some patients. Patients undergoing ongoing treatment and women in their second or third trimester are encouraged to apply to BCBSTX to continue to see their physician and remain in network.

The site says that all scheduled procedures won’t be affected, but surgeries scheduled after Oct. 3 will be considered out of network.

BCBSTX’s Divisional Senior Vice President of Texas Health Care Delivery Shara McClure says that SWHR is demanding a significant reimbursement increase over the next 32 months. “The Dallas-Fort Worth region is already the most expensive health care market in Texas with costs that are 16 percent above the national average,” she said in a statement. “SWHR’s rate demand is clearly not in the best interests of our members, Dallas-Fort Worth businesses, or the communities we serve.”