Reporting Jack Fink
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DALLAS (CBSDFW.COM) – Lynn Riley is worried about her healthcare. “I really don’t want to lose my doctor.”
But that’s exactly what could soon happen to her and thousands of other North Texans. “I just really feel comfortable talking to her, and confiding in her and I really don’t want to start over with another doctor like that.”
She may have to because of a dispute between her health insurer, Blue Cross-Blue Shield of Texas and Texas Health Resources, which operates numerous medical facilities across the region, including Presbyterian Hospital Dallas, where Riley sees her doctor.
Riley found out about this after receiving a letter from Texas Health Resources. “It’s going to be a real disappointment if I have to let her go and find someone else.”
The companies can’t agree on a new contract that begins January 1. If there is no agreement, any services provided by Texas Health Resources would be considered out of network.
That means Riley and thousands of others would have to pay more out of their own pockets. “I can’t afford to do that.”
Experts say these kinds of disputes between health care insurers and providers will become more frequent. This as the industry prepares for the health care law to go into effect fully by 2014.
SMU law professor Nathan Cortez says the newly passed healthcare reform law imposes new requirements on insurers now, and will do so on providers in the future. “Health reform changes the terms of the negotiation. I wouldn’t be surprised to see this happening across the country right now. It’s interesting to see these negotiations being made public.”
As for Lynn Riley, she has a message for both companies. “Why don’t ya’ll meet in the middle and everyone would be happy.”
Nothing changes for any consumer through the end of the month, and even afterwards, there are exceptions.
State law says those undergoing certain treatments such as chemotherapy and women who are pregnant in their 24th week or later, would not be kicked out of their network — some coverage would continue – but consumers should check with Blue Cross-Blue Shield of Texas.
Experts say consumers should call both Blue Cross-Blue Shield and Texas Health Resources and pressure them to come to an agreement.