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CMH will no longer be participating in the BCBSTX Blue Advantage HMO effective immediately

By November 9, 2023No Comments

We regret to inform you that Cogdell Memorial Hospital will no longer be participating in the Blue Cross Blue Shield of Texas (BCBSTX) Blue Advantage HMO network effective immediately. This only impacts individuals purchasing Blue Advantage HMO products. Cogdell Memorial Hospital continues to participate in the BCBS Traditional, PPO, and Blue Essentials Networks.

Cogdell Memorial Hospital did not take this action lightly. Blue Advantage HMO currently pays our hospital less than our cost to deliver services. For example, BCBSTX Blue Advantage HMO maternity care reimbursement is less than half the amount reimbursed by Texas Medicaid. As a result, a portion of the related costs are passed onto the hospital district and community residents. This situation is not economically sustainable.

We have been working to renegotiate this contract for almost 12 months. Blue Advantage reimbursement has not changed significantly since 2013. To move the process forward Cogdell Memorial Hospital delivered a 180-day termination notice on March 10, 2023, providing ample time for both sides to reach mutually agreeable reimbursement terms. We are disappointed in this result.

Cogdell Memorial Hospital participates with several other health plans you can purchase through the federal health insurance exchange or a local health insurance broker. We can provide a list of local health insurance brokers if you wish to contact one of them.