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Blue Cross Blue Shield patients could lose coverage for Baylor Scott & White providers in July

Baylor Scott & White operate hospitals around Texas, including the Baylor Scott & White Medical Center- Lake Pointe in Rowlett.
Baylor Scott & White Medical Center- Lake Pointe
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Baylor Scott & White operate hospitals around Texas, including the Baylor Scott & White Medical Center- Lake Pointe in Rowlett.

The two Texas health care giants are struggling to come to terms over reimbursement rates as costs for medical services rise.

The largest nonprofit health system in Texas and the state’s most prolific insurer are locked in a contract dispute that could affect care for hundreds of thousands of people in Texas.

Richardson-based Blue Cross Blue Shield of Texas said it received a notice from Dallas-based Baylor Scott & White Health in May announcing that it would terminate its physician and hospital agreements with Blue Cross unless a new contract is achieved by July 1. The hospital system and the insurer are in the process of negotiating reimbursement rates for health care costs between Blue Cross and Baylor providers.

Baylor Scott & White has notified patients covered by Blue Cross insurance that they will be considered out-of-network at Baylor facilities after July 1 if the two parties can’t reach an agreement.

“Our patients are our priority, and we’re continuing to negotiate in good faith to prevent any disruption,” a Baylor spokesperson said in an emailed statement.

Some patients, including those who are already hospitalized or undergoing treatment before July 1 may still qualify for coverage, according to Baylor. Such patients could also include those being treated for a disability, an acute condition, or a life-threatening illness.

Many Texas A&M University-Commerce employees have Blue Cross Blue Shield of Texas health insurance. Blue Cross has about a quarter of the market share among Texas health insurers, with more than 5 million members across every Texas county, according to the Texas Department of Insurance.

Baylor Scott & White has 52 hospitals and over 800 patient care sites across Texas, including hospitals in Rowlett and McKinney. In Hunt County, Baylor has clinics in Greenville and Royse City.

“We’re working closely with Baylor leadership and hope to sign new contracts before July 1,” Blue Cross said in a statement on its website. “We value our relationship with BSW, but it’s also important that the contracts we agree to are fair for our members and the local businesses we serve.”

Blue Cross has had down-to-the-wire negotiations over reimbursement rates with several other health care providers in recent years. In early 2023, Blue Cross struck a deal with Ascension days before a deadline. It has also come to last-minute deals with UT Southwestern Medical Center and Texas Health Resources. The Dallas Morning News reports Texas Health Resources and UT Southwestern received about a $900 million increase in reimbursements from Blue Cross over a 32-month period in the most recent agreement.

If Blue Cross and Baylor do not come to terms, Blue Cross-insured patients will see increased out-of-pocket costs if they wish to continue seeing Baylor providers. Baylor said patients who are receiving an active course of treatment may qualify for “Continuity of Care” benefits through Blue Cross and should contact their insurance provider to apply.

Disclosure: Full-time KETR staff and some Texas Newsroom staff receive benefits through the Blue Cross plans.

The Texas Newsroom
Mark Haslett has served at KETR since 2013. Since then, the station's news operation has enjoyed an increase in listener engagement and audience metrics, as well recognition in the Texas AP Broadcasters awards.