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Central Texas Medical Center: News


Important Information for Patients with Blue Cross Blue Shield of Texas Insurance
Adventist Health System and Blue Cross Blue Shield of Texas (BCBSTX) have been negotiating a new contract for care BCBSTX members receive at the following facilities:

 • Central Texas Medical Center
 • Metroplex Adventist Hospital
 • Rollins Brook Community Hospital

The current contract is set to expire on April 6, 2014, and if we are unable to agree to a new contract by then, we will be out-of-network for patients with BCBSTX commercial insurance.

It was only after careful consideration that we determined BCBSTX has left us with no option but to issue a termination. This is not something we take lightly. The bottom line is that we have not received an adjustment in payments from BCBSTX in a number of years and we need a new contract that pays us acceptable rates. BCBSTX has historically underpaid our hospital. We have not realized a rate increase from BCBSTX for a number of years, yet every other large insurance company provides regular increases. Despite not getting any increase from BCBSTX, our costs to provide care increase each year. This has created a significant gap and put our hospitals under financial strain. We are asking for a double-digit rate increase, which we are willing to phase in over time. We are not asking for more than we need to ensure we are able to meet our commitment to our community.

We will use the time between now and April 6 to ensure our patients with BCBSTX commercial insurance have continued access to our hospital. In the meantime, we will keep the community updated with any progress. We want to continue our long-standing relationship with BCBSTX, and our goal is a new contract that works for all parties.

FREQUENTLY ASKED QUESTIONS

Q: What is the issue between Adventist Health System and BCBSTX?
A: For the past several years, Adventist Health System has been trying to persuade BCBSTX to agree to reasonable rates for the care we provide at Central Texas Medical Center, Metroplex Adventist Hospital, and Rollins Brook Community Hospital. Our current contract is set to expire April 6, 2014. If we are unable to agree to a new contract by then, we will be out-of-network for patients with BCBSTX commercial insurance.

Q: What are the negotiations about?
A: Despite not getting any increase from BCBSTX, our costs to provide care increase each year. This has created a significant gap and put our hospital under financial strain. We cannot continue to accept low reimbursement from BCBSTX that will jeopardize our unwavering mission to deliver compassionate, high-quality healthcare to those who need it.

Q: Who is impacted by the negotiations?
A: The contract we are negotiating covers care for patients with BCBSTX commercial insurance at Central Texas Medical Center, Metroplex Adventist Hospital, and Rollins Brook Community Hospital.

Q: Are physicians affected by these negotiations?
A: No, physician office visits are not currently impacted by our negotiations and are in-network for BCBSTX commercial members. However, if we are unable to renew our agreement by the April 6 deadline and a patient needs to be referred or admitted to the hospital for care, that care would be out-of-network.

Q: What does this mean for me if I have BCBSTX insurance?
A: For now, nothing changes for our patients with commercial BCBSTX insurance. However, if we are unable to sign a contract by April 6, 2014, we would be out-of-network. We are doing everything in our power to come to terms on a fair contract before that date to protect your ongoing, in-network access to our hospital.

Q: What if I have an emergency situation?
A: It is important to know that you can always access emergency services at any of our hospitals. Emergency services are always covered at in-network benefit levels. If you have a medical emergency, you should always go to the nearest hospital for immediate care.

Q: What should I do if I have a question about my benefit coverage?
A: If you have questions about your benefit plan or how a specific treatment will be covered if we are out-of-network, please call us at 512-753-3894. We can help you get the answers you need.

Q: What if I am pregnant or receiving care for a special condition when the contract ends?
A: Certain patients may be eligible to receive “Continuity of Care” benefits with BCBSTX. This includes patients who are currently hospitalized when the contract ends, receiving ongoing treatment for special conditions, patients currently receiving active treatment for an acute or chronic condition, women in their second or third trimester of pregnancy, or women completing post-partum care. Continuity of Care benefits ensures that patients receive the medically necessary care they need at the facility of their choice for a designated period of time. We encourage you to call the number on the back of your BCBSTX insurance card to determine whether you qualify for Continuity of Care. If you are not getting the answers you need, please call us at 512-753-3894 and we can help.

Q: How will my care be affected if you go out-of-network on April 6, 2014?
A: If we do go out-of-network, your coverage at our hospital could be limited and will depend on the type of plan you have. Some plans have out-of-network access, but the plans may require you to pay more money out of your own pocket to receive care with us. Only certain patients may be granted Continuity of Care at in-network benefit levels. You should contact BCBSTX to determine if your care or procedure will continue to be covered as an in-network benefit after April 6 because of your condition. Regardless of what happens, you can always access care through our Emergency Department.

Q: What if I want to schedule a surgery/procedure/appointment after April 6, 2014?  
A: We encourage patients, if possible, to schedule the surgery/procedure/appointment before April 6, 2014. However, if patients are unable to do that, please do move forward with scheduling the surgery/procedure/appointment at your soonest possible convenience. We want nothing more than a fair contract with BCBSTX and will work toward a new contract. Either way, we will work with patients to help get the care they need. Please call 512-753-3894 for specific questions about how patient care may be impacted.

Q: What other insurance options are accepted at the hospital?
A: We are currently in-network with many other insurance providers. You can find a full list on our website at www.ctmc.org/patients-visitors.

Q: How can I stay updated on the issue?
A: We will continue to keep affected patients and others in the community updated about our negotiations, so they can make informed decisions about their healthcare. However, we encourage you to contact us at 512-753-3894 or visit www.ctmc.org if you have any questions. We can help you get the answers you need.

Q: Why are you asking for double-digit increases?
A: BCBSTX has historically underpaid our hospital. In fact, we have not realized a rate increase from BCBSTX for a number of years, yet every other large insurance company provides us with regular increases. In addition, medical costs have increased annually by over 6% for the past several years. This means that fixed costs, like supplies, continue to increase in price, while BCBSTX payments stay the same or decrease, putting our hospital under financial strain. We are only asking for the rate adjustment we need to make up for the years of low payments and are willing to phase these adjustments in over time. BCBSTX will say this is a significant increase and more than they are willing or able to pay in order to keep healthcare costs low for their members, but the fact remains that they’ve been paying less than other insurance companies. Our hospital can no longer afford to go without a rate increase from BCBSTX, our state’s largest insurance company. If BCBSTX had been paying our hospital appropriately for services all along, we wouldn’t be in the position we are now.

Q: Why are you bringing your patients into this issue? Isn’t it just between your hospital and BCBSTX?
A: We value transparency and want our patients to know how our negotiations could impact their access to care at our hospital in the future. We don’t want anyone to be caught by surprise.

CONTACT US: We understand the uncertainty this situation can create, and we are here to answer your questions. Please contact us today – we can help.

817-753-3894
ann.berghammer@ahss.org


Location

Central Texas Medical Center
1301 Wonder World Drive
San Marcos, TX 78666
512.353.8979