Metroplex Adventist Hospital patients who are insured through Blue Cross Blue Shield of Texas will now have to go out of network for some services if they want to continue care at the Killeen hospital.
After several months of negotiations, the contract between Metroplex and Blue Cross Blue Shield of Texas expired and was not renewed Monday.
“This is certainly not the outcome we wanted, but we remain fully committed to working with our patients to continue providing the care they need with their local community-based hospital,” said Carlyle Walton, president and CEO of Metroplex Health System. “We are working diligently to help BCBSTX members understand their options and ensure a smooth transition. ...We know this situation can be stressful and we are here to help.”
A contract between the insurance provider and Rollins Brook Community Hospital in Lampasas also expired Monday.
While negotiating, Walton said Metroplex was willing to accept a deal with Blue Cross Blue Shield, provided the company would agree to engage a third party to ensure their service rates were fair and in line with what the insurance provider pays other hospitals for the same services in the market.
The insurance provider rejected Metroplex’s offer.
The decision affected 3,323 Killeen Independent School District employees who use Blue Cross Blue Shield as their insurance provider, said Steve Cook, chief personnel officer for Killeen ISD.
Cook said the district informed its employees that access to emergency services at Metroplex are in network, but some services may be out of network.
“Also, members may access other providers in the area, such as Seton and Scott & White,” he said.
Matt Maxfield, CEO at Seton Medical Center Harker Heights, said he can’t predict the long-term effects of the change at Metroplex, but he expects patients who do their homework will chose a hospital, like Seton, that has in-network services for Blue Cross Blue Shield users so they don’t have to go out of network.
“We have seen a few patients already that have contacted us and called the hospital requesting to move some of their (physician care) or procedures (from Metroplex to Seton),” Maxfield said. “We are definitely ready to serve those patients that feel like they need to make a change and stay in network.”
Dr. Robert Morrow, the regional chief medical officer for Blue Cross Blue Shield of Texas, said he feels “strongly” that the insurance provider offered a fair and reasonable reimbursement rate in its proposed contract.
Morrow said the hospital’s request asked to increase its reimbursement rate 10 times the rate of inflation, which would equate to $5 million in additional costs annually for Central Texas Blue Cross Blue Shield members.
“We work hard on our members’ behalf,” Morrow said. “We work hard to protect them from unreasonable cost increases.”
Walton said he is disappointed that the months of negotiations between the two entities did not result in an agreement.
“We are obviously very open. We want to get this resolved,” he said. “We will continue to care for Blue Cross Blue Shield patients.”
Certain Metroplex services will not be out of network for Blue Cross Blue Shield members. For more information, go to BCBSTX.com/adventist.