1. Court orders Blue Cross & Blue Shield of Texas to place ETMC Tyler in network for its PPOs
2. ETMC Tyler sues 3 insurance carriers for $1M
3. Year in Review: Health trends focus on mental health, access and new medical facilities

TYLER (KYTX) – Blue Cross Blue Shield of Texas intends to appeal an injunction granted in its legal battle with East Texas Medical Center, a spokesman told CBS19 Saturday. Thursday, a Smith County Judge issued an injunction that requires the insurer to immediately add ETMC’s Tyler hospital to its preferred provider organization or PPO health plans.

BCBSTX’s goal has always been to balance access to and affordability of health care in Tyler and across the state,” wrote Gustavo Bujanda, a spokesman for the insurer. “BCBSTX is disappointed with the courts’ decision but is taking steps to comply with the order as required.”

Without the injunction, Judge Jack Skeen ruled, Blue Cross’s actions would result in irreparable harm to ETMC and the public.

“This situation has skewed ETMC’s patient make-up to such a degree that ETMC is now losing money on its hospital operations each month,” Skeen wrote in his ruling granting the injunction.

ETMC filed suit in June, claiming that Blue Cross and Blue Shield of Texas and other insurers were unfairly leaving the hospital out of their PPO plans.

In response, BCBSTX denied the allegations.

“BCBSTX is disappointed with the court’s decision but is taking steps to comply with the order as required. BCBSTX maintains that is has always acted lawfully and provides adequate PPO networks to serve our members’ needs,” Bujanda wrote. “BCBSTX intends to appeal the order. The court’s order requires BCBSTX to include ETMC in its PPO networks. Until the order expires or is overruled, ETMC will be considered in BCBSTX’s PPO networks.The order does not impact any current BCBSTX PPO network provider. Those providers are still available to serve our members in Tyler, Texas.”

While Blue Cross’s HMO network includes ETMC Tyler, its PPO network excluded ETMC, which made services at ETMC far more expensive for tens of thousands of East Texans.

“In a PPO, they would pay at a reduced rate, so it could still be hundreds or thousands of dollars to go out of network,” said Clyde Clubb, a certified navigator with Special Health Resources of Texas in Longview.

Blue Cross announced earlier this year that it would no longer be offering PPO plans on the Healthcare Marketplace, although employer-based plans would continue.

Clubb said the situation points out the need for consumers to be informed about their health care coverage.

“And they should call their provider to make sure they’re going to be in the network, the networks change, doctors come in and out all the time, so should call and make sure their doctor’s going to be in the network,” Clubb said.

The open enrollment period for the Marketplace is underway now, and runs until January 30.

A trial date for the ETMC case is set for next November, although the case could go to trial in April if both sides agree.