UT Southwestern/Texas Health Resources and BCBSTX Network Negotiation Frequently Asked Questions
February 20, 2025
What is happening?
UT Southwestern / Texas Health Resources (SWHR) is negotiating their network contract with Blue Cross Blue Shield of Texas (BCBSTX). The current network agreement is in place through March 31, 2025. Should new contract terms not be agreed to by March 31, 2025, SWHR will no longer be in the BCBSTX network as of April 1, 2025.
Medicare Advantage plans are required by Centers for Medicare Services (CMS) to provide 45 days’ notice to patients prior to a provider contract terminating. UT CARE™ members will receive letters from BCBSTX mid-February. Texas Department of Insurance (TDI) requires PPO plans to provide 30 days’ notice. UT SELECT™ members will receive letters on or near March 1, 2025.
Q. The letter I received indicates the name of a provider I don’t recall seeing. Why?
A. If the letter you received lists the name of a provider you don’t recognize, it’s possible you received services from an ancillary provider involved in your treatment. For example, the provider listed might be a physician who read your x-ray or CT scan, or it may be an anesthesiologist who participated in a surgery. By requirement, any physician who provided treatment within the past 3 years must be listed as part of the notification process.
Q. Will I be able to see my current UT CARE providers?
A. The UT CARE plan is an ‘Open Access’ PPO, meaning members can go to any providers who: 1) accept Medicare; 2) agree to see you as a patient; and 3) agree to submit claims to Blue Cross and Blue Shield of Texas. As long as a provider agrees to these three items, a patient may see that provider. The decision to meet the criteria above is determined by SWHR.
Q. Will I be able to see my current UT SELECT PPO providers?
A. Yes. You can continue to see your current UT SELECT PPO provider at UT Southwestern or Texas Health Resources, but any UT SELECT claims will process as out-of-network and out-of-network benefits will apply if a new contract is not agreed to by April 1, 2025.
Q. Why does the letter from BCBSTX tell me Southwestern HR will not be in the network unless a new contract is signed, but then explains if I am in an Open Access plan, I am not restricted to use the BCBS network?
A. UT CARE is an ‘Open Access’ PPO plan. Any provider who accepts Medicare assignment, agrees to see you as a patient, and agrees to bill BCBS will be paid. Providers who have contracted to be in the BCBS network will be paid their contracted rate. Providers who are not in the BCBS network will be paid the Medicare allowable rate for your care. You can see providers inside and outside of the BCBS network who agree to accept Medicare and bill BCBSTX. Providers outside of Texas can file claims with their local BCBS plan and are familiar with this process.
Q. If SWHR leaves the BCBS network, will I continue to have access to other BCBS network doctors, health care professionals, hospitals and facilities throughout North Texas?
A. Yes. There is a robust network of doctors, health care professionals, hospitals and facilities throughout North Texas. Log into Blue Access for Members of UT CARE or Blue Access for Members of UT SELECT to view provider options or call Customer Service at the phone number located on the back of your UT CARE or UT SELECT PPO plan ID card.
Q. How will I know if SWHR and BCBSTX sign a new contract before April 1, 2025?
A. Keep up to date on the status of the negotiation at www.bcbstx.com/swhr
Blue Cross Blue Shield Settlement Information
February 1, 2025 - Update
The Court process and all appeals have been completed. Claim determination notices are being emailed on a rolling basis.
Please check the BCBS Settlement website for additional details.
November 1, 2021 - Update
To receive a payment under this settlement, you must file a claim no later than November 5, 2021.
The Court in charge of the case will decide whether to approve the Settlement. Payments will be made only if the Court approves the Settlement and after any appeals are resolved. Please be patient as the Court works through the entire process, which can be lengthy.
July 7, 2021 - Update
After further discussion with JND Legal Administration, the firm responsible for the settlement with Blue Cross and Blue Shield, we have been advised the UT SELECT and UT CONNECT plans are part of the settlement and that subscribers enrolled in either plan between February 2008 and mid-October 2020 may file a settlement claim. We have further been advised that settlement amounts of $5.00 or less will be rejected and provided to UT SELECT and UT CONNECT plans directly.
April 29, 2021 - Update
Many UT SELECT and UT CONNECT participants may have recently received an email notification about a federal court settlement in late 2020 related to a class action antitrust lawsuit involving Blue Cross Blue Shield (BCBS). Please note the important information included here regarding the settlement in relation to your UT Benefits coverage.
- Email notices were sent out by the contracted settlement administrator to UT SELECT and UT CONNECT members with email addresses on file within the Blue Access for Members (BAM) system. Many of these emails were automatically routed to spam or junk folders. The email is from a legitimate source but the settlement being referenced is NOT applicable for the UT SELECT and UT CONNECT plans.
- Government plans and their participants, including UT SELECT and UT CONNECT, are NOT included in the settlement class and therefore are NOT eligible to participate in the settlement.
- The exclusion of government plans was a determination made as part of the original lawsuit and subsequent federal court proceeding. It is expressly stated as part of the settlement agreement and is not negotiable.
- Individuals who participated as a primary subscriber in another BCBS health plan outside of the UT Benefits program dating as far back as February 2008 through as recently as mid-October 2020 may wish to verify whether they are eligible to participate in the settlement by following the instructions in the email notice or on the BCBS Settlement website.
This information is the extent of what the UT System Office of Employee Benefits is able to share regarding this settlement. The best resource for additional information about the settlement itself, the applicable time frame in which it applies, who is eligible to make a claim, and how to proceed if you believe you may be eligible is the BCBS Settlement website.
