Information for Patients with BCBSTX Insurance
Effective April 7, 2014, Adventist Health System is no longer part of the Blue Cross Blue Shield of Texas (BCBSTX) network of providers. This impacts the care BCBSTX members receive at the following facilities:
• Central Texas Medical Center
• Metroplex Hospital
• Rollins Brook Community Hospital
This is certainly not the outcome we wanted, but we remain fully committed to working with our BCBSTX patients to get the care you need with your local, community-based hospital.
What this means for you.
We recognize you may still want to receive care from Metroplex Hospital or Rollins Brook Community Hospital and are working diligently to help ensure a smooth transition for our BCBSTX patients. It’s important to know that since Metroplex and Rollins Brook are no longer participating providers, in-network access for BCBSTX members will change.
• Every BCBSTX member has access to emergency services and care at Metroplex and Rollins Brook 24/7, at in-network benefit levels, regardless of their benefit plan.
• Many BCBSTX plans offer out-of-network benefits for out-of-network elective services. Members can call the number on the back of their insurance card to verify their out-of-network benefits.
• At this point, the only absolute way to gain in-network access to Metroplex or Rollins Brook is through other health plans. Please talk with your employer, visit our website at www.mplex.org/PatientsVisitors or call 817-551-2701 to discuss your options.
We appreciate your patience and support during this time. We will continue to pursue a resolution that will allow BCBSTX members to continue to access Metroplex and Rollins Brook on an in-network basis.
FREQUENTLY ASKED QUESTIONS
Q: Since you are an out-of-network provider with BCBSTX starting April 7, 2014, what does that mean for me?
A: You can continue to access the hospital and physicians you know and trust. The difference will be in the amount BCBSTX covers and what you have to pay, depending on your plan and your out-of-network benefits.
Q: Who is impacted by Metroplex and Rollins Brook no longer being an in-network provider for BCBSTX?
A: Patients with BCBSTX commercial insurance who want to receive care at our hospital.
Q: Are physicians impacted by Metroplex and Rollins Brook no longer being an in-network provider for BCBSTX?
A: No, physician office visits are not impacted and are in-network for BCBSTX commercial members. However, if a physician needs to admit a patient to the hospital for care, that care would be considered out-of-network.
Q: How will payment for my care change now that you are an out-of-network provider for BCBSTX?
A: Representatives at BCBSTX have said Metroplex and Rollins Brook will be paid directly for the care its members receive. You should see no change with how hospital bills are paid – just in the amount. Depending on your plan, you may have to pay more money out-of-pocket because BCBSTX will pay less on your behalf.
Q: What if I have an emergency situation?
A: You can always access emergency services at Metroplex and Rollins Brook. 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 if am scheduled for a surgery/procedure/appointment while Metroplex and Rollins Brook are out-of-network for BCBSTX commercial members?
A: We will work with you to continue providing the care you need. Please contact Patient Access at 254-519-8150 to discuss how your care may be impacted and what options you have.
Q: What if I am pregnant or receiving care for a special condition when the contract ends?
A: Certain patients are eligible to receive “Continuity of Care” services at Metroplex or Rollins Brook. 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 postpartum 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 254-519-8150 and we can help.
Q: What other insurance options are accepted at the hospital?
A: We are currently in-network with many other insurance providers. There is a full list on our website at www.mplex.org/PatientsVisitors.
Q: Why is Metroplex and Rollins Brook no longer part of the BCBSTX provider network?
A: We need BCBSTX to pay us in line with what they pay other hospitals for the same services. We are disappointed BCBSTX didn’t take our offers seriously and avoid disruption for their members and our patients.
Q: How do I find out what my out-of-network benefits are?
A: For questions about your out-of-network benefits, you should call the number on the back of your insurance card. If you can’t get the answers you need there, please call us at 254-519-8150, and we can help.
Q: How long will you be out of BCBSTX’s network of providers?
A: Unfortunately, we don’t know how long we will be out of the BCBSTX network of providers. While we are committed to continuing our discussion with BCBSTX, we need them to pay Metroplex and Rollins Brook in line with what they pay other hospitals for the same services.
Q: How will I know when you are back in BCBSTX’s network of providers?
A: We will continue to keep affected patients and others in the community updated. However, you can always contact us at 254-519-8563 or visit www.mplex.org if you have any questions or for the latest information.
Q: Is there anything I can do to help?
A: BCBSTX needs to hear from members who want to choose where they receive care. We encourage people to contact BCBSTX to let them know you want Metroplex and Rollins Brook back in their network of providers.
Jack Towsley, Divisional SVP, Texas Health Care Delivery, BCBSTX
Phone: (972) 766-6136
Q: Whom should I contact if I have questions?
A: We are here to help and have a team dedicated to helping patients experience the least disruption in care as possible. You can call Managed Care at 817-551-2701.
We understand the uncertainty this situation can create, and we are here to answer your questions. Please contact us today – we can help.