Blue Cross Blue Shield of Texas: ER docs at 14 DFW hospitals now out of network

Jake Harris, WFAA

April 24, 2019

DALLAS — Clarification, April 24, 2019: This story has been updated to clarify that services provided by in-network hospital staff are still covered by BCBS of Texas.

Customers who have health insurance with Blue Cross Blue Shield of Texas could face skyrocketing bills if they use certain hospital emergency room doctors that are no longer in network after negotiations failed between BCBS and the emergency room contractor, according to a statement from BCBS. The change is effective immediately.

When a patient walks into to an ER, they might assume the ER is run by the hospital it’s attached to. That’s not always the case. While the hospital operates the ER, many ER doctors are actually employed by outside contractors that pair with hospitals.

That’s what’s happening here, where Texas Health Resource ER doctors work for a contracting company called Texas Medicine Resources.

In the statement, which was also sent to all BCBS Texas customers, the largest health insurance provider in Texas said that as of April 15, Texas Medicine Resources (TMR) ER doctors who work at several Texas Health Resources hospitals will be out of network.
“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,” the letter reads.

The hospitals themselves, which include Texas Health Harris Methodist Hospital, Texas Health Presbyterian Hospital Dallas and Texas Health Arlington Memorial Hospital, will still be in the Blue Cross Blue Shield network, but certain doctors who work in TMR ERs will not.

“TMR terminated their contract with BCBSTX, choosing to leave the networks,” BCBS Texas media and public relations director Chris Callahan wrote in a statement to WFAA. “BCBSTX worked hard to keep the doctors in network, unfortunately, their demands were unreasonable.”

Callahan stressed that only the doctors are out-of-network, so services performed by hospital staff at these ERs would be covered at in-network pay levels. But it’s the ER doctors that now have the ability to charge the patient beyond the insurance payment.