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Metroplex may allow BCBS contract to expire in April

Hospital: Blue Cross Blue Shield of Texas underpays

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Metroplex Adventist Hospital patients who are insured with Blue Cross Blue Shield of Texas may have to go out-of-network if they want to continue care at the Killeen hospital.

In a letter sent to patients last weekend, Metroplex announced its contract with Blue Cross Blue Shield of Texas is set to expire April 6.

The hospital said it is terminating the contract because the insurance provider historically underpaid the hospital.

“(The current rates) are unsustainable and hinder our ability to support the communities we serve,” according to the Metroplex letter. “We have not received an increase in payments from BCBSTX (since 2009) and we need a new contract that pays us acceptable rates.”

However, Louis Adams, a Blue Cross Blue Shield of Texas spokesman, said the insurance provider offered Metroplex “a fair and reasonable reimbursement rate” that is in line with what it pays other hospital systems.

“Adventist has requested a large increase for the same level of care and services that would burden our Texas members,” Adams said. “We want to retain Adventist in our provider network; however, we have a commitment to our members to provide access to quality, affordable health care benefits.”

The two entities went through a similar situation in 2005, when Metroplex and Blue Cross Blue Shield were negotiating a financial agreement on insurance reimbursement rates.

The two extended their contract by one month and eventually reached a deal before the contract expired.

Currently, Blue Cross Blue Shield is one of about 25 health insurance providers the hospital partners with, according to the hospital’s website.

The contract will affect patients at Metroplex Adventist Hospital, Rollings Brook Community Hospital and Central Texas Medical Center in San Marcos.

If Metroplex is unable to agree on a new contract, patients may have to pay more out-of-pocket or travel to another hospital for care, depending on their insurance plan, said Shelley Humphrey, a Metroplex spokeswoman.

By Tuesday night, Metroplex and Blue Cross Blue Shield both said they could not provide a number of how many people are affected by the contract.

With about 2,800 teachers in addition to support staff, the Killeen Independent School District is among the largest employers in Killeen, and has Blue Cross Blue Shield as its insurance provider.

Despite the uncertain future of Metroplex and Blue Cross Blue Shield, Steve Cook, chief personnel officer for Killeen ISD, said it’s not unusual for carriers and providers to negotiate up until the contract’s deadline.

“It would be premature for us to say much about it because we don’t know how the negotiations are going,” Cook said. “I plan on talking to Blue Cross Blue Shield myself to kind of find out where they’re going with it.”

Humphrey said the hospital is spending its time between now and April 6 working toward “a fair contract that ensures our patients with (Blue Cross Blue Shield of Texas) commercial insurance have continued access to our hospital.”

Adams also said he’s hopeful the two entities will reach an agreement that keeps costs down.

Contact Sarah Rafique at srafique@kdhnews.com or (254) 501-7553. Follow her on Twitter at SarahRafique or "like" Sarah Rafique.

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