Update on FCH, Blue Cross dispute
Update Feb. 6, 2019: A request for comment from Blue Cross Blue Shield of Texas was unanswered prior to press time, but a representative has responded via email telling the Herald-Gazette the company wishes to relay its side of the dispute. There will be a follow-up if any new information adding to the understanding of the situation becomes available.
More than a year after Blue Cross Blue Shield dropped Faith Community Hospital from its network, the two are still working to resolve coverage issues.
In November 2017, Jack County residents with Blue Cross Blue Shield of Texas health coverage received a letter stating Faith Community Hospital was no longer in the insurer’s network.
At the time, FCH released a statement that the termination of the relationship between the hospital and BCBS appeared to be in retaliation against FCH over a billing dispute involving covered laboratory services provided to Blue Cross’ subscribers.
According to a press release from the hospital, FCH’s causes of action against BCBSTX for breach of contract for the unpaid and underpaid claims for covered outreach laboratory services, breach of contract for retaliation, tortious interference and injunctive relief, is continuing in arbitration before the American Arbitration Association.
“The hospital is seeking actual, compensatory and economic damages against Blue Cross, including reasonable and necessary attorney’s fees, after Blue Cross refused to pay – or fully pay – for covered laboratory services under the hospital’s contracts with Blue Cross, and after Blue Cross terminated its contracts with the hospital without cause,” said FCH General Counsel David Spiller. “The hospital intends to continue to pursue the claims vigorously.”
Previously, the hospital also filed suit against Blue Cross in state court in the 271st Judicial District Court of Jack County, Texas. That case was removed to the United States District Court, Northern District of Texas, Fort Worth Division. Subsequently, that case was voluntarily dismissed, and the claims made in that case were consolidated into the previously pending arbitration.
When Blue Cross Blue Shield notified its members the hospital was no longer in its network, the hospital’s position has been that Blue Cross failed to inform its members that under federal law, emergency care, if required, will be covered as if in-network with no increase in co-pay or deductible to the member. The hospital encourages all Blue Cross members, if they need immediate care, to seek that care at the emergency room closest to the member, without regard to the network status of the facility.
According to the press release, FCH is the only hospital designated by the federal government as an Essential Community Provider in Jack County and is the only provider in an area of over 1,200 square miles providing obstetric services, noting in the last four years, the hospital service region has experienced two hospital closures and one hospital that eliminated obstetrics.
It is currently contracted and in-network with all other major health insurance carriers. Also, none of Faith Community Hospital’s Rural Health Clinics are affected by the termination of Blue Cross’s contract with the hospital. Current patients of the hospital’s Rural Health Clinics should not experience any disruption of services within the clinic or with any of the hospital’s providers.