Kaufman emergency room no longer in state's largest insurance provider network

Published: April 24, 2019
Kaufman emergency room no longer in state's largest insurance provider network

KAUFMAN, Texas — Effective immediately, Texas Presbyterian Health of Kaufman Hospital is among 14 DFW emergency rooms who are no longer in the Blue Cross Blue Shield of Texas network after negotiations failed between the insurance provider and the emergency room contractor.

KAUFMAN, Texas — Effective immediately, Texas Presbyterian Health of Kaufman Hospital is among 14 DFW emergency rooms who are no longer in the Blue Cross Blue Shield of Texas network after negotiations failed between the insurance provider and the emergency room contractor.

Contrary to belief, BCBS says most emergency rooms are not operated by the hospital it's attached to. Many ER doctors, including those who work in Kaufman, are actually employed by third-party contractors that work with hospitals. Currently, Texas Health Resource ER doctors work for a contracting company called Texas Medicine Resources.

BCBS is warning members that they could face steep bills if they use emergency rooms that are no longer in network after negotiations failed between BCBS and the emergency room contractor, according to a statement from BCBS which was also sent to all BCBS Texas customers, the largest health insurance provider in the state.

"We try to negotiate contracts with these outside companies to bring and keep them in network, so you won't have to pay more for services. In some cases, they choose not to contract with us," the letter reads.

Customers who do go to these ERs will likely face steep bills, the letter warns. BCBS is encouraging its members to double-check which hospitals are in-network, and to use an in-network urgent care center or hospital in the case of an emergency.

The letter is below.

“Dear Member:

We want you to know that as of April 15, 2019, the emergency room (ER) doctors at many Texas Health Resources (Texas Health) facilities are no longer in our network. Texas Health is a network facility, but most of its ER doctors work for an outside company, Texas Medicine Resources.

Hospitals across the nation are hiring outside companies to run their ERs and employ the doctors, nurses and other health professionals you see when you visit the ER. Since these outside companies are not in our network, there are no limits to what their providers charge, potentially resulting in significantly higher out-of-pocket costs.

We try to negotiate contracts with these outside companies to bring and keep them in network, so you won't have to pay more for services. In some cases, they choose not to contract with us.

Things to know about emergency care at Texas Health:

While the facilities listed on the following page remain in our network, the doctors with Texas Medicine Resources who staff their ERs are out of network as of April 15, 2019.

You may get multiple bills, including one from Texas Health and one from Texas Medicine Resources. This can vary based on the care you received.

Because they are out of network, Texas Medicine Resources doctors can charge you more than our allowed amount.

All plans help pay for medically necessary emergency care services. Go to the nearest hospital or urgent care when you have a true emergency.

Our goal is to serve your health care coverage needs through all of life's changes. If you have any questions, call us at the number on your member ID card. Our team stands ready to help.

Sincerely,

Your Customer Advocates

Blue Cross and Blue Shield of Texas”

The emergency rooms located at the following hospitals are no longer in the BCBS network:

Texas Presbyterian Health of Kaufman Hospital is one of only two emergency rooms in Kaufman county.