Memorial Hermann said in a statement that being out of network will affect patients at more than 265 hospitals and care delivery sites. Memorial Hermann's statement indicates negotiations have been ongoing for the past six months for new agreements to "more appropriately cover the care our affiliated providers, as well as Memorial Hermann hospitals and facilities, deliver to patients with BCBSTX commercial (employer-sponsored) and Medicare Advantage health plans."
Memorial Hermann identified several issues it said were important to the hospital group.
"Memorial Hermann remains committed to engaging with BCBSTX in meaningful discussions that put our shared patients and members first, but we will not accept any Physician Group or Accountable Care Program proposal from BCBSTX that dismantles the essential resources that allow Memorial Hermann to deliver exceptional and affordable care," the statement said.
A news release from James Campbell, senior manager of communications of BCBSTX, states the following member plans are affected by the split:
- Blue Choice PPO SM
- Blue Essentials SM
- BlueHPN SM
- Medicare Advantage PPO SM
- Medicare Advantage HMO SM
"We were hopeful throughout the negotiations that we would reach a mutually beneficial agreement, and despite the termination will continue to work towards an agreement," Campbell said. "We have great respect for Memorial Hermann as an organization, but we continue to focus on what is best for our members and customers."
Campbell added some Memorial Hermann physicians and health care professionals have elected to contract separately to remain in BCBSTX.
"For members whose providers have not chosen to contract directly with BCBSTX, we are making every effort to make sure members are moved to in-network doctors, hospitals, and surgery centers as seamlessly as possible," Campbell said. "We are also working with in-network hospitals to speed up granting privileges to doctors who only have privileges at Memorial Hermann so they can continue to care for our members."
Both Memorial Hermann and BCBSTX have indicated current members who are being treated for a pregnancy, disability, acute condition or life-threatening illness may have continuity of care coverage, and a form will need to be filled out.
BCBSTX members are encouraged to contact the customer service number on the back of their member ID cards for more information moving forward.