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CHI St. Luke’s Health: Deal with Blue Cross Blue Shield will be retroactive

CHI St. Luke’s Health: Deal with Blue Cross Blue Shield will be retroactive

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Blue Cross Blue Shield of Texas and St. Luke’s hospitals severed ties for three weeks, but an official said that a new agreement reached last week will mean patients who received care during that time will not have to pay out-of-network prices. 

CHI St. Luke’s Health, whose parent organization is CommonSpirit Health, is made up of 16 hospitals across Houston, Bryan-College Station and East Texas, including the Bryan and College Station CHI St. Joseph hospitals. 

St. Luke’s Health announced Friday night that it had come to an agreement with BCBSTX, bringing back coverage for 65,000 BCBSTX patients who use hospitals in the St. Luke’s Health network. 

Doug Lawson, CEO of St. Luke’s Health, said anyone who was charged for out-of-network care during the past three weeks will retroactively receive an updated charge that reflects in-network rates. 

“We worked very hard to ensure that patients weren’t impacted by this negotiation,” Lawson said. 

On June 17, CHI St. Luke’s Health issued BCBSTX a 180-day notice of termination with intent to renegotiate. In October, Lawson said that Blue Cross Blue Shield of Texas reimbursement rates are 25% or more below competitors’ rates. He said without an increase in rates, the hospital’s ability to function properly could be compromised.

When the two entities failed to reach an agreement by Dec. 16, their contract was terminated. 

While the Friday release states that the hospital’s financial concerns are addressed in the new agreement, Lawson said Monday that some details are still being sorted out, and he could not give specifics on the rates. 

“We do have a broad agreement in place and we’ll be working over the next several weeks to finalize and convert that broad language into the specific hospital fees and fees for the outpatient centers,” he said. “So we have more work to be done. ... We’re happy with the new agreement that we’ve reached. It’s come a long ways towards resolving any market-based inequities.”

Last month, BCBSTX said in a release that CommonSpirit Health was requesting double-digit increases in the prices that BCBSTX members pay. Moving forward with the amount that CommonSpirit requested would have driven up the cost of health care in the Houston area and southeast Texas region, Shara McClure, BCBSTX’s divisional senior vice president for Texas Health Care Delivery said in the December release. 

In a weekend statement, Blue Cross Blue Shield said via email that it worked hard to keep prices for members affordable.

“We advocated on our members’ behalf to keep health care prices affordable, particularly during a global pandemic when access to care is critical,” McClure said.

Blue Cross Blue Shield declined an interview on Monday.

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Economics

Blue Cross Blue Shield of Texas members will no longer see in-network rates at CHI St. Joseph Regional Hospital in Bryan and CHI St. Joseph Health College Station Hospital if officials do not come to an agreement over pricing by Dec. 16. 

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