Blue Cross Blue Shield Texas Announces Medicare Advantage Network Change

Blue Cross and Blue Shield of Texas has made the difficult decision to remove Harris Health System from its Blue Cross Medicare Advantage (PPO)℠ and Blue Cross Medicare Advantage (HMO)℠ networks.

Starting August 1, 2024, Harris Health clinics will be out-of-network for Blue Cross Medicare Advantage members. Hospitals, including Ben Taub and Lyndon B. Johnson, will follow on October 1, 2024. This decision was made to protect members’ and customers’ access to quality care at affordable rates.

Reasons for the Change
Harris Health has been part of Blue Cross Medicare Advantage networks for five years. However, it is significantly more expensive compared to other hospitals in the area, and very few Medicare Advantage members have utilized its services.

Networks Unaffected by the Change
Harris Health will remain part of these Blue Cross and Blue Shield of Texas networks:

• ParPlan
• Blue Choice PPO℠
• Blue Essentials℠
• Blue Premier℠
• Blue Advantage HMO℠
• BlueHPN®
• MyBlue Health℠

Members of Blue Cross Medicare Advantage Flex (PPO)℠ and Blue Cross Group Medicare Advantage Open Access (PPO)℠ can continue to receive care at Harris Health at the same coverage level for covered benefits, provided Harris Health agrees to see them, accepts Medicare assignment, and submits claims to Blue Cross and Blue Shield of Texas.

Member Notifications
Members will receive notices at least 45 days before the effective date. Those with a Harris Health primary care or behavioral health provider will also be contacted by phone about the network change. The company will work closely with members to redirect their care to nearby in-network providers.

Impact on Doctors, Clinics, and Hospitals
Members might still be able to see their healthcare providers if these professionals practice at non-Harris Health locations. Members should discuss this possibility with their doctors, and member outreach will provide additional information.

The following Harris Health clinics will be out-of-network for Medicare Advantage members starting August 1:

• Acres Home Health Center
• Aldine Health Center
• Baytown Health Center
• Casa De Amigos Health Center
• Cypress Health Center
• Danny Jackson Health Center
• El Franco Lee Health Center
• Gulfgate Health Center
• Martin Luther King Jr. Health Center
• Northwest Health Center
• Pediatric & Adolescent Health Center − C.E. Odom
• Pediatric & Adolescent Health Center − Pasadena
• Settegast Health Center
• Squatty Lyons Health Center
• Strawberry Health Center
• Vallbona Health Center

Starting October 1, the following hospitals and other facilities will be out-of-network:

• Ben Taub Hospital
• Ben Taub Tower Specialty Clinics
• Fournace Place
• LBJ Hospital
• Quentin Mease Health Center
• Smith Clinic
• Finding In-Network Care

Members will continue to have access to other in-network doctors, hospitals, and facilities throughout the Houston area. Blue Cross and Blue Shield of Texas is committed to helping members find quality, cost-effective in-network care. Members can explore options by:

• Visiting the online Provider Finder® or their provider directory
• Logging into Blue Access for Members℠ or their online member portal
• Calling the customer service number on their member ID card
• Primary Care Providers and HMO Plans
• Members with HMO plans will be assigned a new, in-network primary care provider (PCP) on August 1. They may visit getbluetx.com/mapd/providers or call 1-877-774-8592 for assistance in selecting a new provider.

Care for Ongoing Conditions
Members who are pregnant or being treated for a disability, acute condition, or life-threatening illness may qualify as continuity-of-care patients. This allows them to receive care at in-network rates at Harris Health, even if it is no longer in-network. Members can call the number on their member ID card for more information about eligibility.