Name: 65K Blue Cross patients to lose access at CHI St. Luke's
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65K Blue Cross patients to lose access at CHI St. Luke's

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Roughly 65,000 Blue Cross Blue Shield of Texas members will lose in-network access to CHI's Texas locations, including its flagship Baylor-St. Luke’s Medical Center, by the end of Wednesday as negotiations stall in a dispute over health care costs.The hospital network and insurer announced in October that they would part ways. CHI St. Luke’s CEO Doug Lawson said at the time that Blue Cross Blue Shield of Texas, along with another insurance carrier, Molina, were paying the hospital system "significantly" less than its competitors for the same services.“Our goal throughout these negotiations has simply been to receive fair reimbursement that will allow us to continue providing critical care to our community," Lawson said in a statement. "All we're asking for is a reimbursement rate that will sustain the value-driven care that so many in Houston depend upon."Lawson said the hospital has made “substantive changes” to their reimbursement proposal.“We hope that Blue Cross Blue Shield of Texas will see past making profit and put the patients and care providers first,” he said.Shara McClure, senior vice president of Texas health care delivery for Blue Cross Blue Shield, said the hospital appears to be committed to leaving the network based on its negotiations since notifying the carrier in June that the system would not renew its contract without rate increases.“We knew we wouldn’t be able to meet the price increase demands,” McClure said.CHI St. Luke’s charges significantly less for hospital services compared its two biggest competitors in town, Memorial Hermann and Houston Methodist, according to data collected by the RAND Corp., a Santa Monica-based think tank. Standardized hospital admissions prices averaged $16,479 at CHI St. Luke’s compared to $17,525 at Memorial Hermann and $20,330 at Houston Methodist.The prices collected by RAND indicate that CHI St. Luke’s might be justified in seeking higher payments from insurers such as Blue Cross Blue Shield of Texas, said Vivian Ho, a health economist at Rice University’s Baker Institute of Public Policy.“I don’t think they had much of a choice,” Ho said.But if the hospital ends up exiting the network, it could raise costs for both insurers and the insured. Ho said. Blue Cross Blue Shield of Texas would be forced to pay more for services when patients get care at CHI St. Luke’s more expensive competitors.McClure, the insurance executive, said additional out-of-network costs incurred by patients who go to CHI St. Luke’s hospitals for emergency care after the contract ends, along with the costs of redirecting patients to other health systems, would be “roughly half” of what CHI St. Luke’s is asking for in its price negotiations.Health insurance premiums are stable going into 2021, following a year in which as many as 7.7 million Americans lost health coverage during the pandemic. While some customers saw minor price increases, most premiums stayed around the same price.Ho, the health economist, said it’s unlikely that CHI remains out of Blue Cross Blue Shield’s network for too long.“This will eventually get settled because they rely too much on each other’s business,” she said. “It’s a game of chicken. I feel so sorry for patients who are caught in the middle.”This story has been updated.&nbsp;gwendolyn.wu@chron.comtwitter.com/gwendolynawu

Roughly 65,000 Blue Cross Blue Shield of Texas members will lose in-network access to CHI's Texas locations, including its flagship Baylor-St. Luke’s Medical Center, by the end of Wednesday as negotiations stall in a dispute over health care costs.The hospital network and insurer announced in October that they would part ways. CHI St. Luke’s CEO Doug Lawson said at the time that Blue Cross Blue Shield of Texas, along with another insurance carrier, Molina, were paying the hospital system "significantly" less than its competitors for the same services.“Our goal throughout these negotiations...

65K Blue Cross patients to lose access at CHI St. Luke's

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