Two healthcare giants are in a contract dispute. This Austin family is caught in the middle.

Jan. 3 was a strange day for Leslie McGuinness-Monclova, a parent and UT Austin employee.

Her father turned to her and said he saw her on TV. A friend too.

She starred in a testimonial ad for Dell Children’s Medical Center, where her son Tavi has received life-saving treatment for anemia over the past few years. In the 30-second spot, she talks about the quality of care her son is receiving. Tavi beams at the end, “My doctor is the best!”

Hours later, McGuinness-Monclova received an email from Ascension, the hospital network that operates Dell Children’s, saying she might have to find her son — a literal poster child for the hospital, she jokes — a new health care provider.

A screenshot of the Dell Children’s ad featuring Leslie McGuinness-Monklova and her children.

McGuinness-Monklova is one of thousands of Central Texans unsure of their health care options as Ascension renegotiates its health care payment contract with Blue Cross Blue Shield of Texas, the state’s largest insurer. If no deal is reached by the end of the month, at least 66,000 customers could have to pay more out of pocket for specialist care. Many were frustrated by the lack of communication about what would happen next.

Days after receiving that email, McGuinness-Monklova said the TV clip featuring her son had been replaced with another one. She said she made the ads “in good faith” because of the level of care doctors take to help her son with his rare form of anemia, a condition in which a person’s immune system attacks his red blood cells.

“Dell Children’s is only in Austin,” she said. “We will not be able to use Dell Children if this policy comes true and they are no longer on the network.”

McGuinness-Monklova said she understands these negotiations are fairly common, but the lack of information from UT, her employer, and HEB, her husband’s employer, who also uses Blue Cross Blue Shield (BCBS), is disappointing.

If negotiations fail, she may have to go to Temple or Houston for Tavi’s checkups.

Neither Blue Cross Blue Shield nor Ascension would make anyone available to speak to KUT about the process or patient concerns for this story.

Ascension said in a statement, “without a commitment to reasonable terms, our current agreement with BCBSTX will end” after this month. All told, Ascension operates UT Dell Medical Center, Ascension Seton Medical Center and dozens of clinics in Central Texas — 54 facilities by count.

BCBS said it “negotiated in good faith and is committed to reaching an agreement that will continue to give BCBSTX members access to Ascension’s facilities at a fair cost.”

Continuity of care

It is important to note that no everyone one of those 66,000 Blue Cross customers (or their dependents) will be out of network on February 1st.

Jolie Sanchez, a patient advocate who helps people navigate health plans and insurance policies, says Texas’ continuity of care laws require an insurer or hospital to keep a patient in network if undergoing life-saving treatment.

“Ascension said if they’re currently in treatment for something, pregnancy, some life-threatening illness,” she said, “they can continue their care through Seton and if they’re in the middle of treatment, they won’t be kicked out of the system.”

“I’m worried if this deal doesn’t go through, there’s going to be a lot of people surprised by that.”

Jolie Sanchez, Patient Advocate

If the patient is 24 weeks pregnant and their OB/GYN is at an Ascension facility, the patient will be covered through labor all the way through postpartum care and the six-week checkup.

Patients with an acute condition, disability or life-threatening illness, such as cancer, will not be excluded from their treatment immediately if Blue Cross and Ascension cannot reach an agreement.

Blue Cross has repeatedly said it doesn’t charge for trauma care and that customers can get emergency care even if it’s at an out-of-network hospital.

But Sanchez is concerned the change will still affect care, since Ascension hospitals provide the highest level of care in Central Texas for things that aren’t necessarily urgent care.

“Seton is the only level one trauma center, and Dell Children’s is clearly the best children’s hospital in Central Texas,” she said. “And so many people depend on it and their specialists.”

And Sanchez said it’s possible some BCBS customers could be kicked off the network. If that’s the case, she said, they may have to appeal that decision through their insurer. A consistent problem she faces is that people often don’t pay attention to their insurance until their coverage changes — sometimes drastically.

“I’m worried if this deal doesn’t go through, there’s going to be a lot of people surprised by that,” she said. “So … I hope people start paying attention to this.”

Sanchez urges Blue Cross Blue Shield customers to contact their insurer to determine if this is possible.

Behind closed doors

McGuinness-Monklova said she did not know whether or not Tavi’s care met continuity of care laws. Tavi receives treatment that is life-saving, but not emergency. She fears she will have to pay out of pocket for hematologist appointments.

McGuinness-Monklova said she was perfectly willing to make the transition to Texas Children’s Hospital in Houston rather than spend thousands on out-of-network coverage.

While she understands that these negotiations often take place behind closed doors, she says Ascension’s handling of it suggests that “the left hand doesn’t know what the right hand is doing,” she said.

“It doesn’t seem like it has anything to do with health care and people, and I thought health care was about people.”

Leave a Comment

Your email address will not be published. Required fields are marked *