The December 3, 2010 issue of the Dallas Morning News had a very good article on this subject, written by Jason Roberson. The article is titled, “Blue Cross Blue Shield, Texas Health Resources dispute may raise costs for Texas Patients”. The current contract between Texas Health Resources and Blue Cross Blue Shield is up for renegotiation as is standard procedure in health care. These contracts come up for renewal every year or so, giving doctors, hospitals, and insurance companies the opportunity to re-evaluate the contract’s effectiveness. Does it help enough patients? Does it cover the services that most patients need? Do the doctors get paid enough for those services to be able to pay their overhead and continue helping patients? Are the insurance companies losing or making money on a particular contract? Is the particular doctor or hospital still a good fit for the network’s members based on current malpractice history, etc? These contract negotiations are really very important to everyone, especially the patients.
If a doctor or hospital doesn’t get paid enough from an insurance carrier to cover its costs, they won’t be able to continue in the business of medicine to continue helping patients because they will slowly (or rapidly) go out of business. On the other side, insurance carriers must make significant profit in order to continue providing insurance coverage over the long-term. The unfortunate reality is that costs do rise and these rising costs do affect businesses, including medical businesses.
In today’s economic environment, consumers (patients) are right to be concerned over how these dilemmas will affect their health coverage. Who’s going to cover the increase in costs? Patients will eventually pay higher premiums because employer-sponsored plans are going to cost more to the employers. So, employers will pay for the cost increase as well. Some doctors are even going to pay for increases by either having their contracts terminated or reduced. That move will cost patients the ability to see a doctor that they already know and trust. Often, that is too high of a cost.
If Texas Health and BCBS don’t come to an agreement (and they probably will), patients with BCBS insurance will have to go to another hospital. In Denton, that doesn’t seem like a very big deal since we also have Denton Regional Medical Center. The problem is that even though DRMC is a fantastic hospital, the influx of new patients could cause lots of long wait times and it could stress the hospital’s current staffing situation making their normal excellent patient care more difficult to accomplish. Patients that stay with Texas Health would have to pay more money out of pocket and who’s really going to want to do that? Other patients will go to urgent care facilities like WOLMED and still others will avoid hospitals all together.
But really, I believe this deal’s too big to not get done and there will be too much public and political pressure to get a deal done. The hospital wants one thing and Blue Cross Blue Shield wants another thing. The deal is probably somewhere in the middle.
For what it’s worth, WOLMED Medical is quite satisfied with its current Blue Cross Blue Shield contract. We realized that rising costs do not necessarily have to put us in a bad position to operate. So, we’ve taken necessary steps over the last 24+ months to lower our operating costs so that we can continue helping our many Blue Cross Blue Shield patients. We’re not a hospital and our costs are surely no where near the level of a hospital, so I feel for those hospital administrators who have to balance high costs with payments that may not reach costs. But the bottom line is that in a medical office, there are 2 ways to stay financially above water: lower costs or get paid more. I have more control over costs than I do over getting an insurance giant to pay us more. So, cost control it is.
I feel like this enormous deal between Texas Health and Blue Cross Blue Shield will get done. In the mean time, WOLMED Medical Doctors in Denton, TX are available to help you with your family medical needs. We want to be your doctor too.