TexomaCare Terminates Participation in Blue Cross/Blue Shield of Texas Network - KTEN.com - No One Gets You Closer

TexomaCare Terminates Participation in Blue Cross/Blue Shield of Texas Network

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From news release:

TexomaCare terminates participation in the Blue Cross and Blue Shield of Texas network

After years of trying to resolve contractual differences, the TexomaCare Physician Group has announced that effective July 1, 2008 they will no longer be contracted with Blue Cross and Blue Shield of Texas (BCBSTX).

As this termination date nears, TexomaCare Physicians want to express their sincerest regrets to their patients and the community for the potential disruption this might cause to the delivery of healthcare in our service area. "As physicians, our primary goal is to provide patients with quality healthcare.  In doing so and while maintaining annual practice cost increases, we must be reimbursed at fair and equitable levels," says Robert Sanders, MD, Chairman of the TexomaCare Policy Board.

Patients may still access TexomaCare physicians for their healthcare needs.  However, depending on the BCBSTX benefit plan options available, the patient may or may not have an out of network benefit. As a courtesy, TexomaCare will continue to file claims to BCBSTX. It should be noted that this termination does not affect BCBS Secondary Medicare Supplement plan members and does not affect Texoma Medical Center (TMC) as TMC will continue to remain contracted with BCBSTX at this time.

According to Nancy Gill, Director of Managed Care, "It's disappointing that after many years of dedicated participation with Blue Cross and Blue Shield of Texas, they are not willing to reimburse the TexomaCare physicians fairly for the services they provide. Unfortunately, it's our patients that will be inconvenienced. We are simply asking BCBSTX to reimburse TexomaCare at fair and equitable levels compared to that of their competitors in our market."

Since 2004, BCBSTX has continually reduced the TexomaCare fee schedule and is the lowest payer among all of TexomaCare's managed care contracts competing with BCBSTX.   Research indicates this is a common theme among physicians and physician groups statewide.

TexomaCare remains committed to working with patients, employers and agents during this transition period and with BCBSTX to avoid disruption in healthcare delivery. Maintaining and restoring our patient relationships are key.  TexomaCare is hopeful that they still might reach a mutual agreement in the future with BCBSTX for a new contract, and encourages all those affected by this termination to voice their concerns about this issue with BCBSTX directly.

In North Texas, TexomaCare is made up of a group of over 30 physicians providing healthcare in the areas of Family Medicine, Internal Medicine (including Endocrinology), Pediatrics, Obstetrics and Gynecology, Gastroenterology and Pulmonology. These physicians have offices in Denison, Sherman and Bonham, Texas.