100,000 Blue Cross Blue Shield patients lose coverage at Memorial Hermann

Blue Cross Blue Shield of Texas and Memorial Hermann health system have terminated their contract after failing to agree on terms, forcing more than 100,000 Memorial Hermann patients to find care elsewhere or pay higher fees.

Issues reportedly centered on independent physicians affiliated with the hospital system. It is said BCBS wants some 3,000 independent doctors to contract directly with the insurer rather than through Memorial Hermann, which had previously negotiated the doctors' rates.

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Both parties said they will continue discussions but, meanwhile, Memorial Hermann patients covered by Blue Cross Blue Shield will lose in-network status. That means they'll need to pay higher fees if they continue with care through the Memorial Hermann system.

Specific plans involved include Blue Choice PPO, Blue Essentials, BlueHPN, Medicare Advantage PPO, and Medicare Advantage HMO. Patients admitted to the hospital before March 1, when the contract expired, will continue to be covered in-network through the patients’ stay.

About 1,000 Memorial Hermann physicians have decided to contract separately to remain in the Blue Cross Blue Shield network. Some patients, however, have had to change doctors to avoid disruptions in coverage of ongoing care.

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