Analyzing the Aftershock: The Blue Cross Blue Shield and Kelsey-Seybold Fallout
Both doctors and patients alike were left scrambling after contract talks between Houston-area clinic Kelsey-Seybold and insurance provider Blue Cross Blue Shield broke down late last year and forced thousands of patients to find new health care providers.
On Oct. 1, 2016, Blue Cross Blue Shield of Texas terminated its contract with Kelsey-Seybold Clinic and nearly 100,000 patients lost their coverage. Not only was this was a massive deal for parents like Adrian Hopkins and Paula Patterson — who were unable to get different insurance providers and were forced to find new health care providers for their children — it was also a huge blow to the patient base of Kelsey-Seybold’s 470 doctors.
“We loved our doctor and we loved her practice,” Hopkins said. “She had been with both of our kids since they were born and our experiences with her were phenomenal every visit. So to go from that type of service to being bounced around to multiple providers with fluctuating costs across the board and having to reconcile all that with your insurance is a pain.”
Patterson and her son dealt with similar issues. They had been with their doctor for 14 years and are still looking for a replacement.
“It has honestly been a terrible time trying to find a new pediatrician for my son,” Patterson said. “The Humble clinic was five minutes from our house and the level of care was fantastic. Now, we’re driving all across Houston only to get worse service at a higher cost.”
Even patients who were able to switch insurance providers have had issues. Reina Barton loved her family’s pediatrician, so she switched from Blue Cross Blue Shield to Cigna in order to keep going to Kelsey-Seybold.
“Thankfully, my company offers us a few insurance providers and we were able to change,” Barton said. “But it still isn’t great. We’ve ended up paying more for less. We have a higher premium with Cigna and they don’t cover all the things that Blue Cross Blue Shield did.”
These complaints are not falling on deaf ears. Dr. Jakeen Johnson, a pediatrician at the Kingwood clinic, is one of many Kelsey-Seybold physicians who has voiced concern over the ordeal.
“It’s been difficult,” Johnson said. “I’ve had patients who have had kids and those kids are now my patients. You have this relationship with them. I’ve been invited to weddings and quinceaneras because they feel that they are part of my family and that I am part of theirs. So it was very hard, there were lots of tears from both sides.”
The Effect on Kelsey-Seybold Clinic
For all the impact Blue Cross Blue Shield’s contract termination has had on the patients, the repercussions for Kelsey-Seybold have been equally severe.
According to Johnson, primary care specialties like pediatrics and OB-GYN were the departments hit hardest by the exodus of patients.
“The unfortunate thing about being part of a multispecialty clinic like Kelsey-Seybold is that the majority of our babies that are born come from OB-GYN,” Johnson said. “So if the OB-GYN department took a 30 percent hit, then pediatrics took that hit with them because all those moms and their babies had to go somewhere else.”
These numbers are pretty similar across all Kelsey-Seybold clinics. Dr. Jagjit Khairah, an OB-GYN specialist at the Kelsey-Seybold clinic in Fort Bend, has also noticed a downturn in patient traffic.
“My personal practice consisted of 30 to 35 percent Blue Cross Blue Shield patients,” Khairah said. “To be a doctor that has worked for over a decade and to watch about a third of your practice walk out the door because of an insurance negotiation falling through is very tough. You have to dig down deep and work really hard to try and rebuild that patient base. It hurts on multiple fronts.”
Eventually, Kelsey-Seybold needed to make some difficult choices in order to stay profitable and deal with this decrease in traffic.
“Clinic wide, throughout Kelsey-Seybold, we had providers that went from 23 or 24 patients a day to seven or nine patients for the whole day,” Johnson said. “So, as a department, we had to make some hard decisions. We were overstaffed by 18 full-time pediatricians at the height of the Blue Cross Blue Shield mess. So, some people that were full-time switched to part-time and some people were let go. It was bad, we were struggling to survive.”
How Did It Get Here?
The world of health care insurance is complex and the situation between Blue Cross Blue Shield and Kelsey-Seybold is no exception. Both sides share the blame for allowing it reach this point and negatively impact the lives of so many people.
Moving Forward and Looking Towards the Future
However, it is not all doom and gloom for Kelsey-Seybold Clinic as its prospects are finally trending upward after months of uncertainty. The company has started implementing a variety of policies to improve and promote their service.
- In response to patient complaints during the Blue Cross Blue Shield contract negotiations, Kelsey-Seybold is improving their communication with patients to ensure they aren’t surprised by a similar situation again.
- They have started accepting new insurance providers to make up for the loss of Blue Cross Blue Shield.
- They have started advertising more. Most clinics now have signs in the surrounding area promoting walk-in appointments for kids.
“In my practice, I already see it bouncing back,” Johnson said. “I have new patients coming in that are insured by companies we weren’t previously accepting. Even though our department is smaller now, I believe we can be smaller and vibrant. Especially with our developments in telemedicine, I truly believe our best is yet to come.”