Two health care giants are in a contract dispute. This Austin family is caught in the middle.

January 3 was a strange day for Leslie McGuinness-Monclova, a parent and UT Austin employee.

Her father approaches her and says that he has seen her on TV. A friend did too.

She was on a testimonial ad for Dell Children’s Medical Center, where her son Tavi received life-saving treatment for anemia over the years. At the 30-second spot, she talks about the quality of care her son is receiving. Tavi finally smiles, “My doctor is the best!”

Hours later, McGuinness-Monclova received an email from Ascension, the hospital network that runs Dell Children’s, saying she might need to find her son. — a literal poster child for the hospital, she jokes — a new health care provider.

A screenshot of a Dell Children’s ad featuring Leslie McGuinness-Monclova and her children.

McGuinness-Monclova is one of thousands of Central Texans who are uncertain about their health care options as Ascension renegotiates its contract for health care payments with Blue Cross Blue Shield of Texas, the state’s largest insurer does. If they don’t reach a deal by the end of the month, at least 66,000 customers could face paying more out-of-pocket for specialized care. Many people are frustrated by the lack of communication about what’s going to happen next.

A few days after receiving that email, McGuinness-Monclova said that the TV spot featuring her son had been replaced by a different one. She said she made the advertisement “in good faith” because of the level of care doctors provided to help her son with a rare form of anemia, a condition in which a person’s immune system attacks their red blood cells.

“Dell Children’s is only in Austin,” she said. “And if this policy passes and they are no longer in the network then we will not be able to use Dell Children’s.”

McGuinness-Monclova said she understands these interactions are fairly common, but the lack of information from UT, her employer, and HEB, her husband’s employer who also uses Blue Cross Blue Shield (BCBS), is disappointing.

If talks fail, he may have to fly to Temple or Houston for Tavi’s checkup.

Neither Blue Cross Blue Shield nor Ascension would make anyone available to speak to KUT regarding the process or patients’ concerns for this story.

“Without the commitment of appropriate terms, our current agreement with BCBSTX will expire after this month,” Ascension said in a statement. All told, Ascension runs UT Dell Medical Center, Ascension Seton Medical Center and dozens of clinics in central Texas — 54 facilities by its count.

BCBS said it was “negotiating in good faith and is committed to reaching an agreement that will continue to provide BCBSTX members access to the Ascent facilities at a reasonable cost.”

continuity of care

It is important to note that no everyone One of those 66,000 Blue Cross customers (or their dependents) will be out of network on February 1.

Jolie Sanchez, a patient advocate who helps people navigate health care plans and insurance policies, says Texas’s so-called continuity of care laws If a patient is undergoing life saving treatment then the insurer or hospital needs to be in network.

“Ascension has said that if they are currently being treated for anything, for pregnancy, for some life-threatening diseases,” she said, “they can continue their care through Seton, and if they If you’re mid-treatment, they won’t be kicked out of the system.

“I worry that if this deal doesn’t go through, it will surprise a lot of people.”

Jolie Sanchez, patient advocate

If a patient is 24 weeks pregnant and their OBGYN is at an Ascension facility, the patient will be covered through postpartum care and six-week checkups through delivery.

Patients with a serious condition, disability or life-threatening illness, such as cancer, will not be immediately removed from their treatment if Blue Cross and Ascension cannot reach an agreement.

Blue Cross has repeatedly said it does not bill for trauma care, and customers can get emergency care cover even if it is at an out-of-network hospital.

But Sanchez worries the change will still affect care, because Ascension Hospitals provides the highest level of care in Central Texas for things that aren’t necessarily emergency care.

“Seton is the only level-one trauma center, and then Dell Children’s is clearly the best children’s hospital in Central Texas,” she said. “And so many people are depending on him and his experts.”

And, Sanchez said, it’s possible that some BCBS customers may be kicked out of the network. If so, he said he may have to appeal against that decision through his insurer. One perennial problem they face is that people often don’t pay attention to their insurance until their coverage changes — sometimes drastically.

“I worry that if this deal doesn’t happen, it will shock a lot of people,” she said. “So … I hope people are starting to pay attention to this.”

Sanchez urged customers under Blue Cross Blue Shield to contact their insurer to determine if this is a possibility.

behind closed doors

McGuinness-Monclova said she doesn’t know whether Tavi’s care would qualify under continuity of care laws. Tavi’s treatment is life-saving, but it is not emergency care. She fears she’ll have to pay out of pocket for a checkup with a hematologist.

McGuinness-Monclova said she is perfectly prepared to drive all the way to Texas Children’s Hospital in Houston rather than spend thousands on out-of-network coverage.

While she understands that these talks often take place behind closed doors, she says that Ascension’s handling of it shows that “the left hand doesn’t know what the right hand is doing,” she said.

“It didn’t seem like it had anything to do with health care and people, and I thought health care was people-centered.”

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