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January 3rd was a strange day for Leslie McGuinness-Monclova, a mom and employee at the University of Texas at Austin.
Her father approached her and told her that he had seen her on television. A friend also saw it.
She was featured in a testimonial ad for Dell Children’s Medical Center, where her son Tavi received life-saving anemia treatment for the past two years. In the 30-second ad, she talks about the quality of care her son is receiving. Tavi finally said: “My doctor is the best!”.
Hours later, McGuinness-Monclova received an email from Ascension, the hospital network run by Dell Children’s, saying she might have to look for her son—which she jokes was a literal nod to a hospital ad. The poster child is – a new health care provider.
McGuinness-Monclova is one of thousands of Central Texans who are uncertain about their health care options as Ascension renegotiates its health care payment contract with Blue Cross Blue Shield of Texas, the state’s largest insurer . At least 66,000 policyholders could face paying more for specialized care if they don’t reach an agreement before the end of the month. Many people are frustrated by the lack of communication about what is going to happen in the future.
A few days after receiving that email, McGuinness-Monclova said that the TV commercial featuring her son had been replaced with a different one. She said she made the announcements “in good faith” because of the level of care doctors gave her son with a rare form of anemia, a condition in which a person’s immune system attacks their red blood cells.
“Dell Children’s is only in Austin,” he said. “And if this policy goes through and they are no longer in network then we will not be able to provide care for Dell Children.”
McGuinness-Monclova said she understands these talks are fairly common, but the lack of information from the University of Texas, her employer, and HEB, her husband’s employer who also uses Blue Cross Blue Shield (BCBS), is disappointing.
If talks fail, he may have to go to Temple or Houston for Tavi’s medical appointments.
Neither Blue Cross Blue Shield nor Ascension made anyone available to speak to KuT about the process or patient concerns for this story.
“Without commitment to reasonable terms, our current agreement with BCBSTX will expire after this month,” Ascension said in a statement. In total, Ascension operates UT Dell Medical Center, Ascension Seton Medical Center and dozens of clinics throughout Central Texas – 54 facilities, on its own.
BCBS said it was “negotiating in good faith and is committed to reaching an agreement that will continue to provide BCBSTX members access to the Ascension facility at a reasonable cost.”
continuity of care
It’s important to note that not every one of those 66,000 Blue Cross members (or their dependents) will be out of network on February 1.
Jolie Sanchez, a patient advocate who helps people navigate health care plans and insurance policies, says Texas’ so-called continuity of care laws require an insurer or hospital to keep the patient in-network. if you are receiving life saving treatment.
“Ascension has said that if they are currently being treated for anything, for pregnancy, for some life-threatening conditions,” he said, “they can continue their care through Seton, And if they’re in the middle of treatment, they won’t be thrown out of the system.”
I am concerned that if this agreement is not reached, many people will be surprised by it.
Jolie Sanchez, patient advocate
If patients are in the 24th week of pregnancy and their gynecologist is at the Ascension facility, medical coverage will continue through postpartum care and six-week check-ups.
In the event that Blue Cross and Ascension do not reach an agreement, patients with serious illnesses, disabilities, or life-threatening conditions such as cancer will not immediately stop receiving treatment.
Blue Cross has repeatedly stated that it does not bill for trauma care and that customers can obtain coverage for urgent care, even if it is at an out-of-network hospital.
But Sanchez worries the change will affect care, because Ascension Hospitals provides the highest level of care in central Texas for health conditions that aren’t necessarily emergency care.
“Seton is the only level one trauma center, and then Dell Children’s is clearly the best children’s hospital in central Texas,” he said. “And so many people are depending on him and his experts.”
And, Sanchez said, it’s possible some BCBS customers may be kicked out of the network. If so, he said he may have to appeal against that decision through his insurer. One perennial problem they face is that people often don’t pay attention to their insurance until their coverage changes, sometimes drastically.
“I worry that if there is no agreement, a lot of people will be surprised by it,” he said. “So … I hope people start paying attention to this.”
Sanchez urged Blue Cross Blue Shield customers to contact their insurer to determine whether the possibility exists.
behind closed doors
McGuinness-Monclova said she did not know whether Tavi’s care would fall under continuity of care laws. Tavi is getting life-saving treatment, but it’s not immediate care. He fears he will have to pay out of pocket for follow-up appointments with hematologists.
McGuinness-Monclova said she is fully prepared to travel to Texas Children’s Hospital in Houston rather than spend thousands on out-of-network coverage.
While he understands that these talks are often taking place behind closed doors, he says that the way Ascension has handled the matter shows that “the left hand doesn’t know what the right hand is doing, ” They said.
“It didn’t seem like it had anything to do with health care and people, and I thought health care was people-centered.”
Translated by Maria Arce