Court orders Blue Cross & Blue Shield of Texas to place ETMC Tyler in network for PPOs

Published: Nov. 12, 2015 at 9:06 PM CST|Updated: Nov. 30, 2015 at 10:27 PM CST
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TYLER, TX (KLTV) - A Smith County district court has granted an injunction to East Texas Medical Center Tyler, immediately designating the hospital as a preferred provider in the Blue Cross & Blue Shield of Texas (BCBS) preferred provider organization (PPO).

"We have been fighting hard to allow Blue Cross & Blue Shield PPO members to have real choice in their healthcare options," said Elmer G. Ellis, president/CEO of the ETMC Regional Healthcare System. "This decision is a victory for those who value competition, choice, and access to the widest range of local hospital services."

Earlier this year, ETMC Tyler filed suit against Blue Cross & Blue Shield, citing that the hospital's exclusion from the organization's preferred provider networks has created serious and negative impacts on a large group of consumers. In fact, according to Blue Cross & Blue Shield, 30,000 East Texans in Smith County alone are covered under its PPO network.

The suit noted that ETMC is the only level one trauma center in the area, as well has providing the only renal transplant and deep brain stimulation services. Patients needing their services were told that ETMC was out of network for their BCBS of Texas PPO.

"We were forced to take the drastic action of filing this lawsuit to ensure access to the many services offered at ETMC Tyler for this large group of consumers," Ellis said.

Because of this ruling, physicians can refer Blue Cross & Blue Shield PPO patients to ETMC Tyler, where they will receive all in-network benefits, including lower deductibles and copays.

A similar lawsuit was filed in November 2014 by Texas Spine & Joint Hospital in Tyler against Blue Cross Blue Shield. The hospital said it was seeking damages for what it called years of disputed payments for patient care provided to BCBS members. The hospital also argued that BCBS is in violation of the Texas Free Enterprise and Antitrust Act by having only one contracted or "in-network" hospital facility in the Tyler area.

ETMC administrators expect Blue Cross & Blue Shield to appeal the court's decision.

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