Ascension Texas Hospitals May Go Out-of-Network for Blue Cross TX in 2024

Ascension Texas and Blue Cross and Blue Shield of Texas (BCBSTX) are in ongoing contract negotiations that may result in Ascension Texas' 12 Central Texas hospitals becoming out-of-network for BCBSTX insured patients starting January 1. If no agreement is reached, patients with certain Blue Cross plans would face higher out-of-network costs when receiving care at these hospitals, which include specialty centers like Dell Seton Medical Center and Dell Children's Medical Center. This is a recurring issue, as the hospitals temporarily went out-of-network earlier in 2023 before a new contract was finalized. The financial disagreements stem from Ascension Texas citing increased operational costs, especially for equipment and medications, as key challenges. While Ascension Texas' hospitals reported an operating profit of $284 million in 2023, BCBSTX, part of Health Care Service Corporation Group, posted a net income of $659 million in 2024, indicating both parties have substantial financial interests in the negotiation. Hospital systems and insurers routinely review contracts ahead of renewal deadlines to manage cost and network coverage. This potential change affects millions of BCBSTX members, including employees of state entities like the University of Texas and the Teacher Retirement System. The affected insurance plans include Blue Choice PPO, Blue Essentials, Blue Advantage HMO, and several Medicare Advantage plans. Those with plans not explicitly listed are advised to verify coverage by contacting BCBSTX directly. Out-of-network status impacts deductibles and out-of-pocket maximums, often increasing patient costs significantly. Ascension Texas hospitals provide unique services in Central Texas, such as the region's only burn unit, the only heart transplant program, and specialized pediatric cardiac care, emphasizing the clinical significance of maintaining network agreements. Physicians typically have separate contracts, so most doctors remain in-network despite hospital network changes. Both Ascension Texas and BCBSTX recommend that patients verify their coverage and estimated costs before seeking care at any affected facility to avoid unexpected expenses. Historically, if agreements are reached shortly after contract expiration, insurers may retroactively cover in-network rates for services rendered during any coverage gap. This negotiation reflects broader industry dynamics balancing healthcare delivery costs and insurance affordability.