5.16.19 – BCBS and Texas Health Update

Thursday, May 16, 2019

 

BCBS TX and Texas Health Update

As was recently announced on JetNet, the current contract between BlueCross BlueShield (BCBS) and Texas Medicine Resources (TMR), a company staffing physicians for all of Texas Health Resources (THR) emergency rooms, expired April 15, 2019.TMR and BCBS continue negotiations at this time in hopes to come to a resolution.

This means ER providers at many THR facilities will no longer be in the BCBS network. I know many of you are concerned about how this change could impact your coverage for emergency medical services provided at Texas Health Resources facilities in the greater Dallas-Ft. Worth area, and with the assistance of the American Benefits team, we have answers to many of your questions and concerns below.

The American Airlines Health Benefit Summary Plan Description (2019), which can be found by visiting www.my.aa.com,  defines an emergency as an illness or injury that happens suddenly and unexpectedly and could risk serious damage to your health or is life threatening if you do not get immediate care. Poisoning, drug overdose, multiple trauma, uncontrolled bleeding, fractures of large bones, head injury, severe burns, loss of consciousness, hypo and hyperglycemic reactions, strokes or TIA, and heart attacks are just a few examples of emergent conditions referenced as needing Emergency care and treatment. If a team member or covered family member is being transported to an Emergency Room by ambulance, the emergency room treatment is likely to be considered an emergency.

If you believe or feel you have a condition that would require immediate medication or treatment, you should seek emergency treatment at the closest facility to you. During an emergency situation, you should not have to worry about where you can go or who can treat. However, if you need assistance or further clarification in deciding about proper care or your specific illness or injury, and your specific illness or injury allows the time, the 24/7 Nurseline is also available for assistance at 833-346-3929 (833-FIND-WAY). If you have a medical emergency, please seek immediate attention at your closest medical facility and/or call 911 for assistance.

Accolade can help if your closest Emergency Room is a Texas Health Resources facility

If a claim is processed as out of network and not an emergency, but the team member feels the need was emergent – meaning services provided for a person, that, if not provided, would likely result in the need for crisis intervention or hospital evaluation due to concerns of potential danger to self, others, or grave disability, the team member should call Accolade who will request an adjustment to the bill. Once adjusted, the team member will only be responsible for their share as though all services and providers are in-network.

Urgent Care and Doctor on Demand

Another valuable resource to consider for minor illnesses or injuries is an urgent care facility and Doctor on Demand. Should you have an illness or injury more suited to be seen at urgent care or Doctor on Demand, doing so will save you time and money over an Emergency room visit. Download the Doctor on Demand app from the App Store or Google Play. Remember to enter your medical plan information when registering. U.S.-based mainline team members enrolled in the Standard, Value medical options will pay a $20 copay per visit; those enrolled in Core will pay $49 per visit until the deductible has been reached.  To find an in-network urgent care facility close to you, you can contact Accolade at 833-346-3929 (833-FIND-WAY), the same customer service number that you’ll find on the back of your medical ID card.

If you are unsure if your condition can be treated by either an urgent care facility or Doctor on Demand, and your specific illness or injury allows the time, you can contact the 24/7 Nurseline for assistance at 833-346-3929 (833-FIND-WAY). Again, if you have a medical emergency, please seek immediate attention at your closest facility and/or call 911.

DFW residents: In-network emergency room facilities and physicians

If you feel or believe you have an illness or injury that could cause serious risk or damage to your health or is life threatening and you do not seek immediate care, please contact 911. If you or a covered family member would like to locate an in-network emergency room with in-network physicians, here is a list of Baylor Scott & White emergency room facilities with in-network facilities and physicians.

Baylor Scott & White facilities with in-network facilities and physicians:

Baylor Scott & White Grapevine
1650 W. College St., Grapevine, TX 76051

Baylor Scott & White Irving
1901 N MacArthur Blvd., Irving, TX 75061

Baylor Scott & White All Saints (Fort Worth)
1400 8th Ave., Fort Worth, TX 76104

Baylor Scott & White Dallas – Baylor University Medical Center
3500 Gaston Ave., Dallas, TX 75246

Baylor Scott & White Plano
4700 Alliance Blvd., Plano, TX 75093

Baylor Scott & White McKinney
5252 W. University Drive Highway 380 at Lake Forest Dr., McKinney, TX 75071

Baylor Scott & White Centennial
12505 Lebanon Rd., Frisco 75035

Baylor Scott & White Lake Pointe
6800 Scenic Dr., Rowlett, TX 75088

Baylor Scott & White Carrolton
4343 N Josey Ln., Carrollton, TX 75010

Baylor Scott & White Waxahachie
2400 N I-35E, Waxahachie, TX 75165

Baylor Scott & White – Heart Hospitals: Denton & Plano
2801 S Mayhill Rd., Denton, TX 76208
1100 Allied Dr., Plano, TX 75093

In closing, APFA Health would like to thank the entire American Airlines Benefits team for their continued hard work and assisting our team members in staying healthy and well. Without their hard work, dedication, and cooperation, this important solution would not have been possible.

In Unity,

Michael Tipton
APFA National Health Chair
Association of Professional Flight Attendants