Physician group drops Blue Cross Blue Shield Save Email Print
Posted: 5:51 PM Jun 25, 2008
 Last Updated: 3:49 PM Jun 27, 2008
 Reporter: Emi FitzGerald
Email Address: emi.fitzgerald@kxii.com
109 comments
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DENISON, Tex. -- Thousands of Texomans may now have to leave the area for medical care covered by their insurance. Years of failed negotiations have led a local physicians' group to drop one insurance company's contract.

There are about 30 physicians in the TexomaCare physician group, seeing thousands of patients with Blue Cross Blue Shield of Texas insurance. The doctors say after July 1, they will continue to see those patients, but they will have to pay an out-of-network rate.

The TexomaCare physician group announced they will no longer contract with Blue Cross Blue Shield. They notified patients months ago about the change. Doctors say the insurance company reimburses at the lowest rate of all the managed care contracts. They say this rate is too low for them to have the quality of health care patients deserve.

But with primary care physicians, pediatricians, OB-GYNs, gastroenterologists and pulmonologists all under this category, it forces patients to make a tough decision about how and where to get their health care.

"It’s very troubling to us because there's just not a lot of doctors in our area that are going to be able to pickup and take care of these patients. They may have to go into the Metroplex. Pediatrics is one of the areas of real concern," Dr. Duke Carlson says.

We want to stress this does not affect the emergency room and other services of the TMC hospital, nor does it affect those with Blue Cross Blue Shield secondary Medicare supplement.

TexomaCare officials say this is happening with doctor’s offices all across Texas, and concerned patients can call Blue Cross Blue Shield by dialing the number on the back of their ID card.

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Posted by: Bernie Location: Sherman, Texas on Nov 4, 2008 at 08:15 AM
Our company, Terex Reedrill will be cahnging to Blue Cross Blue Shield effective Jan of 2009. The Sherman Denison area is a small community and There are not tht many doctors in the Blue Cross Blue Shield plan. My wife and I have been patients with physicians in the Texoma care network for 15 years. We now have to hunt for a doctor like many others in the area. This is a real shame.
Posted by: SH Location: Bonham on Jul 2, 2008 at 11:18 PM
Bottom line is the doctors get enough of our Money and They All Know it. Losing alot of business is maybe what they don't know yet. Soon to find that out..... Get Smart People !!!!
Posted by: Anonymous on Jul 2, 2008 at 09:02 PM
To Anonymous, 6/30, @8:08... Yes, I DID chose my career. Guess what? I know about expenses, too, because I ALSO have a FINANCE degree! So get off of it about expenses. I know that not one of the doctors that was involved with BCBS would have gone under because of what they were being reimbursed. So lay off the pity trip!! It's a disgrace. I'm not saying that they don't deserve to be paid! But, Sherman doctors don't have any problems taking BCBS. The Denison doctors want the same reimbursement that TMC is getting from BCBS!!!!!!!!!!!!!!!! That is the reason!!!!!!!!
Posted by: Anonymous on Jul 2, 2008 at 08:49 PM
Noone can compare to my children's pediatrician. If an agreement is reached, my children will go back to him. He is wonderful!!
Posted by: AliceIn Location: Wonderland on Jul 2, 2008 at 03:29 PM
Bob T - the last line of your post says it all.
Posted by: Bob T Location: Gordonville on Jul 2, 2008 at 07:36 AM
Dear Dr. Anonymous: You prove what Mrs Paramedic said. What makes you think that education is everyones "option". Life does not afford everyone the same opportunity. Education and the skill to "diagnose" and treat is a privilege and an honor and should be considered so. Medicine is supposed to be an honorable profession-one that is a "calling". Nobody owes you anything and you are no better than I am. So,try counting your blessings and treating those who need your skill and shelve your arrogance. Believe me, God will humble you. HE wont ask how much money you made off of the people you treat,but rather how you treated them when they couldnt fill your pockets.
Posted by: Chilla Location: Sherman on Jul 2, 2008 at 01:00 AM
Dentists do the same. Most in our area don't take BCBS. I know about the cash price/no insurance deal. I didn't pay dental with BCBS because there are no dentist in this area that take it, so I pay the "cash" price, which isn't too bad after paying premiums year after year. Sucks to work for the state of Texas because that's your only choice.
Posted by: Ralph Location: Denison on Jul 2, 2008 at 12:29 AM
Does Health Care Reform = "socialized medicine", or is the term "socialized medicine" used to scare folks into thinking a Commie is sleeping under their bed. Billions in tax dollars are already spent in our current health care system? Neither presidential candidate is proposing reform that even approaches socialized medicine. Unless a plan that provides subsidies to assist some people in paying for health insurance premiums can be considered socialized medicine. To the Doc in OK, I am sure you will be quite successful. You will not only restrict your practice to those who can pay the most, you can also prescribe only those medicines for which you receive the highest kickback, order up tests that provide the greatest profit margin etc. You are afterall, a businessman, and you will treat patients on your terms, without regard to their bottom line, only yours. AND if they don't like it, they can go to Med School. Let them eat cake. You are a poster child for those seeking reform.
Posted by: anonymous Location: ok on Jul 1, 2008 at 09:46 PM
Maybe insurance would pay better if doctors were not such a rip off..i know somebody that told me that their kid had to have x rays and they wanted the cash price because they had no ins. TMC told her normally these xrays were $300 but she got a cash price of $70..what do you think they would have charged my ins co? I am thinking $300. IS this not some form of fraud. I feel as if I am being punished for having insurance because I have a ded. so therefore I would have been out the 300 plus my premium out of my check every two weeks..how is this fair? Also, if I have understood correctly on the out of network, you are going to have to pay fees up front and then file the ins yourself, or so this is what my doctors office at tmc told me. Why should we pay fees up front and premiums? IF this is the case everyone should get the cash price and do away with the ins premiums!!!!
Posted by: Richard Location: Sherman on Jul 1, 2008 at 05:46 PM
I've read several comments below and was wondering about the BCBS reimbursement so I asked my wife who works for a provider in the Sherman/Denison area. She says their reimbursement is quite a bit above medicare and that BCBS is one of the best companies to work with in her office. I wonder why Texoma Care doctors find the reimbursement so disagreeable. She says maybe they think they should be paid more than the rest of the doctors in the area.
Posted by: Anonymous Location: ok on Jul 1, 2008 at 03:23 PM
I read about half of these posts and as a new doc (I'm in OK so I have nothing to do with this problem) have to say I would never contract with BCBS because it pays so poorly. I owe over a million $ for my education, office, and equipment. I too have a family, and we suffered at poverty level or below while I worked hard for my education. We still have a hard time making ends meet. They don't issue you a loaded bank account when you swear your oath you have to earn it. I'm not going to load my schedule down with patients that I'll make little money from. My employees expect to get paid, so I have to make a profit. People complaining so about the way doctors choose to run their own business really irritates me. If you dont like it you have the same option as everyone else. Go to school to be a doc and take care of yourself.
Posted by: Betty Peoples Location: Gainesville on Jul 1, 2008 at 01:50 PM
To Anon at 11:13. What a stupid comment. "Take away the high salaries and we wont have doctors anymore." that statement just cemented what most other folks you DISagree with said. If they are in it for the money-they obviously dont give a rip about you or anyone else. I would have thought being married to a paramedic would mean you actually have a grasp,but you proved otherwise.There are some good ones and there are some jerks. I have seen both and I can tell you they are not underpaid or they would have left the profession by now. You should hear some of the surgeons talk about how they are building their winter residence and then complain about how hard up they are-poor babies--one of them only cleared 875,000 last year. My heart is breaking.
Posted by: Anonymous on Jul 1, 2008 at 11:13 AM
Ralph, socialized medicine is not free from problems either. By the way TX Mom, I'm the one who posted under "Docs deserve their high pay"... I am NOT a doctor (I'm actually married to a licensed paramedic), but I personally know quite a few doctors, and they are very good people, even if they do make a lot of money. Take away the big salaries and we won't have doctors anymore. Switch us to socialized medicine, where their salaries will be paid for by taxes (which means they will earn a lot less, like police/fire/EMS do) and there's going to be a huge shortage of doctors.
Posted by: Ralph Location: Denison on Jun 30, 2008 at 11:36 PM
To Anonymous 6-30, 8:08AM...You are making the same arguments that have been made for decades re: "socilaized medicine". Whether your points are valid or not have little bearing on our situation. Very few are pleased with our current system. This conflict between BCBS and this Dr.'s group illustrates just one of many problems with our current system. Just read the comments (below). High out of pocket expenses, poor care, unnecessary follow up visits, excessive testing, cattle call Dr.'s offices, Dr.'s not being familiar with patients case/medical histories, hidden hospital charges, patients billed for "services" that involve a 2 min. fly-by visit from a Dr. the patient never met before nor even requested his involvement are just some of the problems. Expecting folks to lead healthier lifestyles is not a fix for a broken system. There are SO many healthy (and insured) people who are just one accident away from financial ruin and inferior care.
Posted by: AliceIn Location: Wonderland on Jun 30, 2008 at 09:26 PM
Mom on June 30 - how right you are! Your post hits the nail on the head. Police, fire and EMS do all of the things you listed, and more, all for too little pay. Why? Because they have the heart to be a 'public servant' for the betterment of their community and fellow man. Most doctors put themselves so high on a pedestal that they expect us to serve them. Yes, we couldn't make it w/o doctors, but try making it w/o police, fire and EMS workers. They work for just enough money to make a living because they have a 'calling' to do their difficult job. Doctors choose their job - and yes, it takes alot of school and alot of time, but like Judge on June 30 said, they make a living and have a lifestyle the rest of us can only dream about. To do that they are obviously raking in the money somewhere. The difference between what they expect to be given to them, and what police, fire and EMS expect out of life, are stark. Give me police, fire and EMS anyday, they earn my respect!
Posted by: Judge on Jun 30, 2008 at 02:12 PM
Try to find a doctor without an expensive home, 2-3 luxury vehicles, a country club membership, swimming pool, etc.,etc. Then cry to me about how they don't make enough to cover their expenses. The guy crying about all the school and long hours they put in is obviously not in touch with the real world. What about all the people that work just as many hours for 25% of the pay? At least the soon-to-be doctors had a rich future to look forward to. Many folks do it their whole life wihtout any hope for adequate compensation. Many doctors write up paperwork in non-ethical ways. Fudging the documents to get the most out of your insurance company. Many (not all) doctors are partially to blame for inflated health care costs. This is another example of doctors being in it for the money, not because they want to help people. TexomaCare physicians should be ashamed for not making some sacrifices to help the community.
Posted by: Go to TMC web site Location: Denison on Jun 30, 2008 at 12:58 PM
Go to the TMC website and look at the listings on the Physician Directory. If the doctor is with TexomaCare, it's listed next to their picture.
Posted by: BCBS Location: ho on Jun 30, 2008 at 12:55 PM
hoo gonna get me my pills fo dem genital warts ons my mout?
Posted by: Ben Location: Texoma Area on Jun 30, 2008 at 12:00 PM
Let me understand this? Dr.s in TMC Group are loosing money when BCBS pays them for PPO benefits and Dr.'s outside of TMC Group are glad to accept us and accept BCBS PPO reimbursements? Please explain? Also, why can't the executive management (Dr. Watkins) step in to help resolve this critical/horrible issue? Thanks
Posted by: TX Mom on Jun 30, 2008 at 10:43 AM
To; Docs, Do you really think that you are the only person in this town with a hard job? You chose to go into medical, so any complaining about the time/money you spent getting your education and having to deal with sick people does not really inspire sympathy. Police, Fire Fighters, EMS and others have just as tough a job as you and are paid a he77 of a lot less than you; their response to 911 saves lives, just like doctors, but they don't ask for an insurance card or for a method of payment. And ask DPS how often they have to do death notifications and call family to the hospitals...I don't think all docs are egomaniacs, but your inflated ego comes through loud and clear! My husband was not very imressed with the granite driveway and marble elevator of a doc when we were without insurance and paying full price cash for every visit! Real heroes don't do it for the money!!!
Posted by: Anonymous on Jun 30, 2008 at 08:08 AM
Anonymous @ 10:00, YOU are the one who chose your career. Doctors cannot stay in business for long if they are not reimbursed enough to cover their expenses (they would be losing money- DUH!), and believe me there are a LOT of expenses involved in running a practice. Gads Ralph, I hope healthcare reform is NOT coming... I don't want socialized medicine. I don't want to be taxed to death to pay the medical expenses of people who are totally unwilling to try and live healthier lifestyles (exercising, eating right) to improve their health and prevent illness. EVERYONE will have to pay higher taxes to cover the cost of socialized medicine... and the quality of our healthcare system will go straight down the tube. We'll have to wait a year to see specialists and stuff like that, like they have to do in England and Canada.
Posted by: Anonymous on Jun 29, 2008 at 10:11 PM
is Robert Hernandez one of the doctors that won't accept BCBS anymore??? PPPLLLEEEAAAASSSSEEEEE tell me he isn't!!! He has been a life saver for me since I started seeing him in January. After MONTHS and MONTHS of going to dr after dr to fix my "problems", after ONE visit of 40 minutes (he never rushes me) I had the answers and the remedy I needed. Dr. H.... you can't be one of them.....
Posted by: a on Jun 29, 2008 at 01:19 PM
wait it will get better when they relocate to the new drs offices by the new hospital . who will pay for that ???
Posted by: ex-TMC patient Location: Denison on Jun 29, 2008 at 12:32 PM
I had to spend a few weeks in TMC once. The texomacare docs did their best to kill me. A certain specialist saved my life and he moved to Sherman. Guess where I've been going for medical care since that experience? Texomacare sucks.
Posted by: not afford this Location: tx on Jun 29, 2008 at 11:15 AM
maybe new neighbors to new tmc hosp.will save all their greedy bcbs/tmc/30 drs.is their a list of THE DOCTORS for us to see?
Posted by: Anonymous on Jun 29, 2008 at 10:03 AM
To Sick Lady in Sherman. Call Dr. Sandmann, in Sherman, he is the BEST! I've gone to him for over 12 years. He has performed two major surgeries for me. You will be SO happy!! There is no problem to big for him! :)
Posted by: Anonymous on Jun 29, 2008 at 10:00 AM
To Docs: How could you do this to your patients???? Yes, you need money, we all need money!!! You want to talk about paying back student loans, working with different personalities, having a HARD job, and delivering bad news!! Well, I do this everyday at my job as a TEACHER, and don't make NEAR what you do. In fact, I went to school for 5 years and without my husband's salary, would be considered to live in POVERTY. But, guess what? I would NEVER walk out on my students because I didn't think I was getting paid enough!! What a disgrace!!! It doesn't matter what kind of car I drive, house I live in, or how much money I make.......because I know everyday I am making a difference in someone's life. There are people that are sick and dying....and NOW they have to switch doctors!!! How sad!!!!!!!!!
Posted by: MOO Location: COW on Jun 29, 2008 at 01:17 AM
If you ever go to TMC, you have to be crazy to go back, it is a cattle call hospital.I went there years ago and never went back nor will i ever go back,come on over to WNJ we want your business and except for the (emergency) room it is a great place and the people are great(except for the emergency room personel that suck)if you have an emergency just go to the vets.
Posted by: Ralph Location: Denison on Jun 28, 2008 at 11:10 PM
Three words: Health Care Reform. It's coming. Whether it's due to greedy ins cos., doctors wanting more $, malpractice insurance, whatever... However, it would appear those who are so invested in and so rewarded by the current system would work out a balanced solution so they can keep their respective gigs. This is the system that so many insist is the best in the world, but no one is happy with it, and the political winds blow. Like it or not, a dramatic change is on the horizon.
Posted by: RGCC on Jun 28, 2008 at 11:02 PM
I have BCBS of New Mexico and I called TMC Doctors group insurance and was told my BCBS was included in the contract. I called BCBS in Dallas to complain and was told they had been covered up with calls over the last couple of days and someone would call me right back to take my complaint..........that was Thursday and still waiting by the phone. I did call my BCBS of New Mexico rep and she told me that I could still keep my TMC Dr. and I would just have to pay out of network fees and told me a rule of thumb would be currently In Network pays approximately 90% and Out of Network pays approximately 70% with the same deductables practically. Can someone verify that to me that understands insurance? Question: Just wondering why Sherman Dr.'s are fine with BCBS reimbursements and Denison Dr.'s are not? Isn't it the same $$ of reimbursement? If so, I don't understand the problem. My wife and I love our TMC Dr. (Gonzalez) and will pay out of network until an agreement can be reached.
Posted by: sick lady Location: sherman on Jun 28, 2008 at 07:15 PM
I'm in the process of recieving treatment for precancerous cells/ uterine problems. In the middle of wondring if I'm gonna live to see my children grow up, I now have to switch Dr's cause the TMC physician I've been seeing will no longer take my BCBS!!! The treatment is very painful and stressful. I work hard and pay a massive amount for BCBS and I'm getting screwed. I'm just not sure who's Saturday night it is? The TMC physician's group, or BCBS? Maybe it's a threesome! Please pray for me, cause I have to now switch to a completely different Dr in July. The whole situation sucks. I'e been going to my current Dr. for over 10 years! He is a gentle, good Dr who has taken great care of me...
Posted by: AliceIn Location: Wonderland on Jun 28, 2008 at 06:55 PM
Docs, if it's such a great job then why do you sound so unhappy? And yes, the teachers that educated you are the ones suffering long work hours for damn little pay. Yes, as a doctor you deserve respect and the pay you earn, but you make alot (ALOT) more than the teachers that helped you get where you are today...
Posted by: ME Location: HERE on Jun 28, 2008 at 02:10 PM
WHY IS EVERYONE ACTING SO SURPRISED THAT DOCTORS AND INSURANCE COMPANIES WOULD BE SOOOOO GREEDY? THEY HAVE BEEN DOING IT FOR YEARS.
Posted by: Anonymous on Jun 28, 2008 at 12:06 PM
To Docs.....guess what I went to college for 5 years and live on $30,000 a year........try being a teacher!!
Posted by: Anonymous Location: denison on Jun 28, 2008 at 11:52 AM
Docs- By the way you rationalize doctor's high salaries, you'd think teachers would be receive similar compensation. Teachers touch all of our lives in some way or another at some point in our lives.
Posted by: Diana Location: Madill on Jun 28, 2008 at 11:02 AM
I dont blame the docs for this one. BCBS has been difficult and stingy and try talking to the same person twice...nope they charch hughmungus fees for little service...
Posted by: Anonymous on Jun 28, 2008 at 10:59 AM
whats funny a dr will go to africa and help but cant help people here that need it . whats funny i have never seen a dr live in a double wide or drive a pinto it cost to live in a million $$ home , drive a lexus, vacation in europe and furnish with imported crap from china
Posted by: Docs deserve their high pay! on Jun 28, 2008 at 09:01 AM
"The doctors are trying to make a mint; and live the lifestyle they think they are due"- you try going to medical school for 8 years, get into hundreds of thousands of dollars of student loan debt, plus 3 years for a residency (where they work 120 hours a week and have a salary of $30,000/yr IF that), and even more years if you are going into a specialized field, and then you can try telling the doctors that they don't deserve high wages. They have a HARD job. They have a lot to learn and a lot to remember, and they carry the huge burden of finding out what is wrong with people, treating illnesses, delivering the bad news when illnesses can't be treated, etc. They deal with impossible people, drug-seekers (prescription pain pill addicts looking for more drugs), hypochondriacs, people who refuse to take care of themselves and expect a magic pill to fix everything, and high malpractice premiums due to sue-happy idiots who blame everyone else for their problems. It's not an easy job!!
Posted by: Anonymous on Jun 28, 2008 at 08:54 AM
I don't know about other BCBS members, but once I switch doctors..........there's NO GOING BACK. I will NOT switch back to TexomaCare. Not after all of this mess!And, I know of about 25 other patients that won't be coming back, EITHER. You can't tell me that there is noone out there that can solve this dispute. Have you ever heard of LAWYERS? They do more than settle divorces! If TexomaCare negotiates and comes to an agreement, it better be BEFORE July 1st. Otherwise, so long!!
Posted by: Charley Location: Denison on Jun 28, 2008 at 08:44 AM
The sad fact is that it is all about greed. The Doctors are making plenty of money and so are the insurance companies. The rest of us are the saps. This year we are paying the same premium with higher copays and higher out of pockets with BCBS. We continue to pay for both groups living the good live while we struggle to make ends meet. Too bad Hillary won't be elected and make national health care a reality like it is in so many other countries. I have BCBS and my wife and I are saddened to leave TMC. We have already signed up with a doctor in Sherman. If you haven't done so yet then you better get on the ball while there are still some available.
Posted by: ???? Anonymous on Jun 27,2008 at 8:20 pm Location: Fannin on Jun 27, 2008 at 08:29 PM
I work for Trailblazers and we have BCBS of South Carolina and I was told it was all BCBS not just Texas. My husband has several medical conditions and we pay out a lot for drs.care and medicine to keep him alive,we really like our physicians but paying out of network is crazy. I have already gotten a physician in Sherman to take him but it was a challenge because of pre-exiting conditions. TexomaCare Drs. are really going to miss what they say is little payments from BCBS to nothing at all. Maybe they will then realize they have cut their own throats.
Posted by: heathcare proffesional on Jun 27, 2008 at 08:19 PM
I would not be mad at the texomacare group be mad at BCBS they are the ones to blame not the doctors. People have a problem with thinking healthcare is FREE!! Our kids have to eat to! Let me come to your job and tell you Im not going to pay you what it cost to get your services or goods! I bet I wouldnt be a customer of yours any longer either! before casting stones put yourself in some one elses shoes I agree it sucks but be mad at BCBS for there LACK of caring for there consumers health!
Posted by: Anonymous on Jun 27, 2008 at 01:51 PM
In response to ?????? posted at 11:58. Dr. Craig is one of the BEST doctors in this area. If you are looking for a good doctor, try him. In fact, I found him at Urgent Care owned by TexomaCare.........and followed him to Sherman.
Posted by: ??? Location: Denison on Jun 27, 2008 at 11:58 AM
I was told by a TexomaCare Dr. that BCBS reimbursed them 115% of the Medicare rate. (Aetna was next at 130%. You'll be in last place as of July 1, so watch out!) I went to my primary care dr. in January and spent less than 10 minutes with him. I was billed $92. BCBS paid $43.42 and I paid $25. I was told I needed a follow up appt. in Feb. At that appt. I was billed $61 for less than 5 minutes of face time with the doctor. BCBS paid $17.27 and I paid $25. I was told I needed a follow up in March. At that appt. I was billed $61 for less than 5 minutes. BCBS paid $10.93 and I paid $25. No medications, bloodwork, etc. involved in these appts. just a "How are you doing?". I was told to schedule another follow up visit in June, which I declined to do. I've been checked out better by the Wal-Mart greeter. At least they make eye contact with you!
Posted by: Anonymous on Jun 27, 2008 at 11:27 AM
FYI Below are a list of Doctor's that Do want our Blue Cross Insurance. Do you really want to go back to Texoma Care? CHRISTIAN COOPER MD 9038928398 GRANT CRAIG MD 9039570190 JOHN GALEWALER DO 9035643503 CLIFFOR GARVIN MD 9034638448 JASYN HANEY MD 9038928398 BRADLEY HODGE MD 9038928398 ALFRED JOWITT DO 9035647677 TODD KISLINGBURY DO 9035649090 POLLY KNIGHT MD 9034829153 JENNIFE LAING MD 9038910949 BRUCE MANIET DO 9039657700 PAUL MILLMANN MD 9038931399 FRANKLIN NIEBERG MD 9038926392 JOHN PSUTKA MD 9034825181 JAMES RUSSELL MD 9038928398 HELEN SCHULZE MD 9038928398 PAUL WESTMORELAND MD 9034829153 SUSAN WILLS MD 9038935546 JENNIFER WILSON DO 9033423760
Posted by: Dr. Zhivago Location: Russia on Jun 27, 2008 at 10:32 AM
Hey, how about that, it does work! But - oops! It's really me.....Alice. :)
Posted by: AliceIn Location: Wonderland on Jun 27, 2008 at 10:29 AM
Somehow, mainly due to the lack of proper English and punctuation, I don't think that the post by doctors office bonham is actually from a doctor's office in Bonham. But then again, I guess anyone can get on here and call themselves anything they want. So, maybe instead of Alice, my next post will be Dr. Zhivago from Russia. :)
Posted by: doctors office bonham Location: bonham on Jun 27, 2008 at 06:59 AM
my office has rising utilities supplies and equipment, and a load of goverment paper work, not counting inc, paperwork so how are any doctors making enough money to pay the office help who need cost of living raises and dont even have health inc. its not just bcbs its all inc, and no pay patients and dont forget medicaid, how about they all stop taking medicare how about all doctors not take any inc and we all have to pay cash what a mess that would be no one would go to the doctor,,,,
Posted by: Anonymous on Jun 27, 2008 at 06:39 AM
To anonymous who posted comment @ 9:15pm. You can call us cry babies, but you know what we really are! We are HARD-WORKING people that pay ALOT of money for our health insurance. We DESERVE the right to go to WHATEVER doctor we want to. So, call us what you want, we know what we are.
Posted by: Texan Location: Texas on Jun 26, 2008 at 10:21 PM
Close the borders, maybe the cost of healthcare would fall or at least not rise as fast if the illegals and indigents weren't allowed free care. That makes me and the other paying patients with insurance have to pay more to make up for the losses. Just another thing that will be made worse if Hussein Obama gets in office.
Posted by: Butch Location: Sherman on Jun 26, 2008 at 10:12 PM
To anoymous @ 11:14 am.. I understand the dollars involved in becoming a doctor, but that is true for anyone who starts a business from scratch.You have a large start up cost(loan) that you have to repay ovedr time, but they just can't double the charges and expect to stay in business very long.As for the malpractice ins. it's there for a reason, to cover any messed up patient cases that they might have and they do have them! Your right, health is important, but too many tests are ordered that aren't needed, thus driving up the cost of ins. You spoke of illness to people, but some can't be prevented due to genetics. So, I have a brain and you didn't read or understand what was written, I said "both parties are at fault" and it is all about the money.Still the doctors take a oath before they become a doctor, maybe you need to read it!
Posted by: bonham clinic Location: bonham on Jun 26, 2008 at 09:45 PM
maybe if the tmc doctors hadnt sold themselves to tmc they could treat patients like they want and should not just herd them in for 8 to 10 minute apt. maybe they are getting what they ask for
Posted by: BCBS Location: Denison on Jun 26, 2008 at 09:34 PM
I am very upset that this information was not told to us. I heard about this from a friend of mine. I do not understand how the Sherman doctors are going to be able to care for this many people. I am switching insurance policies for my child, but I am locked in to BCBS from my employer. BCBS needs to think about how many people they are going to lose over this situation.
Posted by: Anonymous on Jun 26, 2008 at 09:15 PM
what a bunch of cry babies.
Posted by: Bill Location: Texoma on Jun 26, 2008 at 08:44 PM
Greed. People care more about their firecrackers, christmas lights, cats, and dogs than tehy do usa citizens. OOO and money. Do you think the gas owners and people are making lotsa money? Do you think many people are suffering from gas prices and no one gives a ........?
Posted by: Anonymous on Jun 26, 2008 at 07:42 PM
To Anonymous....posted at 4:51 pm. Something is SO WRONG with that picture. It doesn't make ANY SENSE!!!!!!!!!!
Posted by: perfect scenario Location: denison on Jun 26, 2008 at 07:36 PM
I wonder if reba knows about this and is still willing to invest?
Posted by: Richard Location: Texas on Jun 26, 2008 at 07:01 PM
I have never seen such an ignorant group of people in my life as I have seen in this blog. Nearly all of the BCBS policies are on a "Reimbursement" system. In other words, for you ignorant individuals; if the plan pays out $10,000; then your insurance plan has to pay the $10,000; and guess what; that $10,000 has to be reimbursed by somed one! Try telling your healthcare provider that they are ripping off the payment system. There is no reason that a routine office visit should cost $500 plus. The doctors are trying to make a mint; and live the lifestyle they think they are due! BCBS is doing what they can due to hold down unreasonable cost increases! Think of this; our expenditures for healthcare exceed every other developed country's cost. However, our outcomes are just above those of the least developed countries (Romania, etc). I would like to have a serious debate about TMC Doctors and their screwed up priorities about serious care for their current patients!
Posted by: Anonymous on Jun 26, 2008 at 06:52 PM
In response to the comment by Anonymous at 2:42 pm. You call Tammy's response, "STUPID". Well, from the outside looking in, I can see Tammy's perception of the situation. You obviously have an inside position on this catastrophe. It's real professional of you to call someone's comment, STUPID!
Posted by: Anonymous on Jun 26, 2008 at 04:58 PM
Sue, I'm trying to make fun of the opinion that ANYONE who charges ANYTHING for necessary goods/services must be doing it only for the money. Bill, would you go to work if you didn't get paid for it? No? Well, then you must care about nothing but the money, either.
Posted by: Anonymous Location: denison on Jun 26, 2008 at 04:51 PM
To unhappy: People that have Medicaid are insured, although they are not paying for it. Taxpayers are. This makes me mad. I can't afford insurance now that my employer only pays for 1/2 of mine and none of my dependents. But my husband and I both have full time jobs so we make too much for any assistance...... but the girl down the street has had 2 children by the age of 18, doesn't work, and she is on Medicaid as well as her children. Does this make sense?
Posted by: Lisa Location: Ardmore on Jun 26, 2008 at 04:43 PM
I have to see a endocrinologist,the closest one is Denton/Sherman or OK City. I have been going to TexomaCare for a number of years now, I was just there a few months ago and no one said anything about them no longer taking BCBS starting in July. I will be cancelling my August appointment and will now have to find another doctor. This is all about greed instead of health care. How sad.
Posted by: Anonymous on Jun 26, 2008 at 04:28 PM
Funny, all the ilegals in the ER get to wait in line with me, who is a citizen AND pays for health ins. (BCBS)and THEY don't get hounded to pay before they leave. Guess they get all the free samples, etc. And now, you're going to tell me that any follow ups from an ER visit, I'll have to go elswhere. Shoulda never bought a house in Texoma...... This place sucks.
Posted by: AliceIn Location: Wonderland on Jun 26, 2008 at 04:27 PM
There are many good doctors in Sherman and Bonham that will take your BCBS insurance. The TexomaCare group may have just cut their own throats by dropping this insurance when they see how many patients they lose along with their decision to drop BCBS. It's a shame.
Posted by: Sara Location: Sherman on Jun 26, 2008 at 03:55 PM
TMC didn't notify me of the change in policy. My kids are the ones who will suffer. They have had the same pediatrician for the last 7 1/2 years and would like to keep him. I would like to keep him! With deductibles, premiums and out-of-network costs, this is not feasible. It is sad to see that the almighty dollar will come between medical care and the patients. I have already switched my kids to a Sherman doctor, but I will greatly miss Dr. Brumit. No matter what BCBS paid him, he was the best!
Posted by: TX Mom on Jun 26, 2008 at 03:45 PM
To Anonymous that disagreed with Butch: I understand that doctors must charge afee in order to keep a practice going; however, when Texomacare gathered up all the doctors in the area and instantly doubled prices, I lost any sympathy. It wasn't the doctors that did this is was the Texomacare operation - they took over the doctors, their staff and all the billing. Everybody wants their piece of the pie. If we really want health care in this area to improve we need to remove the middle man. Let doctors go back to running their own business, hiring and firing their own staff and taking care of their own contracts and billing. I'll bet when you eliminate the bureaucracy and red tape, a lot of things would get better! Texomacare ruined local health care.
Posted by: ANITA Location: BONHAM on Jun 26, 2008 at 03:24 PM
While TMC and BC/BS are busy causing a fuss need I remind you all that there are plenty of physicians in this area that are not attached to TMC. My physicians are in Bonham and all my healthcare needs have always been addressed efficently. I am not just tied to one hospital they are on staff at more than just one hospital and when I call I can speak to a real person and get an appointment in a resonable amount of time. So test the waters everything happens for a reason.
Posted by: Vicki Location: area on Jun 26, 2008 at 03:02 PM
My sons' pediatrician is in Denison. He has taken wonderful care of my boys for the past 10 years. He is one of the most kind, caring, smart, and loving doctors. I know that he would never put the children he serves in the middle. I am a BC/BS member, who can't afford to pay out of network. My children have cried over what is happening. I wish him all the best! He is a wonderful, Godly man! I will miss him!
Posted by: Sue Location: Pottsboro on Jun 26, 2008 at 02:45 PM
To Anon at 11:14: if you think the comparison between what a doctor makes and what a farmer makes is parallel-you obviously are out of touch. I have yet to see a tractor with lambo doors parked at the airport while the farmer is on a safari in Africa for a month. Excuse me for not getting on the Pity Party train for the docs.
Posted by: Anonymous on Jun 26, 2008 at 02:42 PM
We already have the money for the facility Tammy, that was a very stupid comment.
Posted by: Anonymous on Jun 26, 2008 at 02:28 PM
I think we "BCBS Participants" Should demand know the exact $ amounts they are fighting over. After all it's our Money!
Posted by: medical biller (non texomacare) Location: denison on Jun 26, 2008 at 02:24 PM
in response to "sad" bcbs does not pay less that medicare, they are not the best reimbursements rates but there are worse. i feel like texomacare is going about this wrong, there are too many major employers in out area that are bcbs. you can't just drop it totally. you should have talked to these employers and see how long they have contracts for. instead by just dropping the contract. you are not thinking about the pt's in your decision making b/c many of them will move dr's there is a huge difference between out of network prices and the extra gas needed to go else where. most of the dr's dropping this ins can be replaced by seeing someone in sherman. the extra 20 miles in gas is ALOT cheaper than out of network prices! it doesn't make sense that they would drop bcbs b/c they were not getting paid enough but yet they are taking medicaid....you barely get paid ANYTHING by them and there is alot more(office)work involved in seeing a medicaid pt than a bcbs pt!
Posted by: Sue Neal Location: Tioga on Jun 26, 2008 at 02:23 PM
Unfortunately,I have witnessed physicians greed first hand. The oath they took is,for most of them,just a technicality on their way to the bank. For those of you who dont believe this,you should hear some of the comments they make when their patients arent around. As for TMC,look at their past record.Well,DUH!!!
Posted by: unhappy Location: denison on Jun 26, 2008 at 02:14 PM
I would like to know how many of these doctors that now won't accept Blue Cross Blue Shield, accept Medicade. In other words, the uninsured. Maybe I should quit my job, stop paying my $600.00 a month health insurance premiums, and live on the government. Then maybe I could use Texomacare doctors.
Posted by: tammy Location: denison on Jun 26, 2008 at 02:04 PM
I wanted to add that I'm not just coming down on Texomacare...BCBS is just as much at fault. What's the use of paying for insurance if you can't even use it locally? Plus, it's Federal BCBS on top of it! Geez!! Heck, I can't even go to a doctor because my job doesn't offer insurance and it's ridiculously high to buy your own!
Posted by: Lisa Location: Denison on Jun 26, 2008 at 02:00 PM
I think TexomaCare is wanting Blue Cross to pay for their new Facitliy! I was told that there are approx. 27,000 BCBS subscripers in this area. Who is TexomaCare going to be taking care of? What's left Medicare/Medicaid Patients!
Posted by: tammy Location: denison on Jun 26, 2008 at 01:48 PM
That's a flat out lie that they notified us months ago about the change. My son has asthma and chronic strep throat and was in the doctor's office in Feb., April and EVERY SINGLE WEEK OF MAY! Not once, was I notified that they were not going to accept his insurance anymore after July 1st! I work in a doctor's office, and it is in NO WAY cheap to pay out-of-network prices. Now I'm forced to find a new doctor when he's had the same pediatrician since birth! I'm steaming mad! I cannot believe they would state that "our" level of care is based on what they get paid! So I guess the people that don't have any insurance at all should just be left to suffer??
Posted by: Bill Location: Texoma on Jun 26, 2008 at 01:40 PM
It is all about the money. BCBS caes about nothing but money. The oil people, money lenders, politicialns and everybody cares nothing about the suffering they cause they onely care about their money. What a great christian predatory capitalistic culture usa has. Aint you so proud?
Posted by: chuck Location: denison on Jun 26, 2008 at 12:13 PM
This comment is for Sad...posted at 11:48. WE PEOPLE, do realize that driving to Plano or Dallas, will cost more money because of gas prices. But, do you honestly think that we believe you saying that we will be paying more than our out of network fees? You've got to be kidding me. Have you ever had to pay out-of-network fees? How will our doctors be working for us? Are they still going to allow us to continue with our set office visit rate? I don't think so!!
Posted by: sad on Jun 26, 2008 at 11:48 AM
The reason why they are doing this is because BCBS is making you the patients and employers pay outrageous premiums and paying the physicians less than what Medicare reimburses. They are not only standing up for themselves, but for you the patients. This is not the first hospital to do this. There have been tons of efforts to reach a common ground, and I think eventually there will be one. BCBS will not negotiate contracts unless a facility has officially terminated their contract and then and only then will they consider. Do you people not realize that if you were to drive to plano, dallas, or where ever, you will be spending more for gas, than to pay the out of network rate?? Your doctors truly care about you and will be willing to work with you.
Posted by: Cindy Location: Area on Jun 26, 2008 at 11:28 AM
BCBS is the worst insurance to get payment from. They have very low payment rates. Anyone that has worked in the medical field in billing will agree. I have them thru my employer and really wish we would switch too.
Posted by: Anonymous on Jun 26, 2008 at 11:21 AM
Rich keep getting richer and the poor keep getting poorer. I pay almost $400 a month for insurance that is now not accepted by the majority of doctors in the texoma area. I am mad at BCBS but also mad at the doctors. All they care about is getting more money and not the patients. What is the world coming to?
Posted by: Anonymous on Jun 26, 2008 at 11:14 AM
Get a brain, Butch. Doctors have hundreds of thousands of dollars in student loans to pay off, tens of thousands of dollars in malpractice insurance to buy every year... yes, doctors make a lot of money, but they cannot afford to practice for free! If they do not bring in money, they cannot afford to stay in business! It's as simple as that! Medical care is a necessity of life... and so is food. Does that mean that farmers, ranchers and grocery stores should give food to everyone for free if the people think it's too expensive to pay for? Should we accuse *them* of greed? Try looking at it from the physicians' point of view. And maybe people should learn to take better care of their own health, too! Just look at how much money is spent on illnesses and conditions related to poor lifestyle choices! Diabetes, heart disease...
Posted by: sue Location: denison on Jun 26, 2008 at 10:48 AM
A quote from the news from TMC hospital, "We want to stress that this does not affect the emergency room and other services of the TMC hospital!"........Do you think that patients will be coming to a hospital or ER if they don't have a primary care physician in the system?? TMC......you should be the one trying to help resolve this matter. Wake up......it will affect TMC, too!!
Posted by: J.R. Location: Sherman on Jun 26, 2008 at 10:11 AM
I am deeply saddened that I too have to change doctors for myself and my child. Because I have to see a specialist, I will now have to lose time off from work to travel to Plano, instead of Denison, to see a physician who will take BCBS. It appears to me that this will have a negative impact on our community. What good is a new medical facility if many of our local residents cannot afford to access it? On the TMC website, it does state that TMC will still file claims through BCBS but that it is likely that insurance holders will have to pay out-of-network prices. It seems that the whole insurance system in our country is painfully overdue for a major overhaul, in which both patients and doctors can have their needs met, instead of the insurance companies being the only ones to "win".
Posted by: Anonymous Location: Denison on Jun 26, 2008 at 09:44 AM
I think it is time we stand up for the doctors who have become part of our families over the years by continuing to care for us, guide us and treat us with the highest quality of care and respect. Consider this....The cost of providing that healthcare increase just like everything else. If all they are asking BCBS to do is increase what they are reimbursing the physicians so they can continue to provide this healthcare then BCBS should quit trying to pad their pockets and help those they insure by helping the doctors cover these increased costs.
Posted by: fed up in Texoma Location: Denison on Jun 26, 2008 at 09:35 AM
All these thousands of people should encourage their employers to drop BCBS and go to other insurance providers. Drop your doctors, too! If they base your level of care on how much they're getting paid for services, they don't deserve your business anyway!
Posted by: new WNJ consumer Location: Denison on Jun 26, 2008 at 09:18 AM
"They notified patients months ago about the change!"................never happened. I heard it through friends!!
Posted by: Butch Location: sherman on Jun 26, 2008 at 09:11 AM
Seems the "Doctors" have forgot about the oath they took when they became doctor's, about the good of the patient! It's all about greed, money.. I haven't received any contact from BC/BS about the drop in coverage, first I knew of it was this story. Who are the doctors that make up the Texoma Care? Both the doctors and BC/BS are at fault. Many people will suffer due to their greet for the dollar.
Posted by: concerned in denison on Jun 26, 2008 at 08:44 AM
Why would TexomaCare physicians make the statement or the reporter for that matter, that the amount the insurance reimburses the doctor, determines the "quality of care the patient recieves"? Does that mean every time a patient goes in to see a doctor, the office runs your insurance or ability to pay and then decide how much or how little they are going to help you before the doctor comes into the examining room? This is a problem with the Insurance Company trying to keep medical costs down by declaring we are only going to pay this much, and when there is a contract they can not charge the patient for the difference. TexomaCare is cancelling the contract because they can charge much more than BCBS will allow their covered insureds to pay. BCBS is doing what they can for their insureds, TexomaCare is trying to get more money out of them. The patients are in the middle, and yes I am a BCBS insured and my TexomaCare physician has yet to post anything, mail anything or notify me at all.
Posted by: Lisa Location: Denison on Jun 26, 2008 at 08:27 AM
Explain this one, My husband takes a blood thinner therefore has his levels checked at least once a month, on his last visit he questioned the Check Out Clerk about BCBS pulling. She explained to him that he could no longer pay his $20.00 Copay for his test, That the charge for the blood test was with No Insurance filed would be $18.00! plus it would apply againest his annual deductible! I'm lost Same test filed with insurance Texoma Care cost us $20.00 plus BCBS pays Texoma Care another $14.00 = $34.00. If you do not file insurance and pay cash for test = $18.00. No wonder our Health Insurance Cost us so much.
Posted by: Anonymous on Jun 26, 2008 at 08:20 AM
That's who I had for insurance through my last job... glad I don't have them anymore!
Posted by: Anonymous on Jun 26, 2008 at 08:10 AM
THEY DEFINATELY DID NOT NOTIFY ANYONE. My wife is a teacher in Denison. My kids have gone to their doctor for years. We will have to now, like every good business, move onto Sherman.
Posted by: J Location: Texoma on Jun 26, 2008 at 08:00 AM
Dr. Carlson is a good DR. and BCBS stinks. I'm checking to see how much it will cost to continue going to him. With gas at $4 a gallon it might be cheaper to stay here.
Posted by: PAT Location: WHITESBORO on Jun 26, 2008 at 07:56 AM
HOW DO WE FIND OUT WHO IS IN THE TEXOMA CARE GROUP. I HAVE HAD BCBS FOR YEARS AND HAVE HAD NO PROBLEMS. I HAVE HAD MANY SURGERIES AND RECOVERED FROM CANCER AND I WAS OUT VERY LITTLE MONEY AND THEY ALWAYS PAID EXTREMELY FAST. SO CAN SOMEONE TELL ME WHERE TO FIND OUT WHO IS IN THIS GROUP?
Posted by: anon on Jun 26, 2008 at 07:41 AM
Your employer is paying a mating portion of at least 50% if not more (excluding any additional family on your coverage) so you can get insurance. Yeah, that's a lot of money when you have a cold or stomach ache, but get cancer and see how much it helps you. Deductibles and Co-Pays are designed to give the customer (you) some of the risk so you won't abuse your coverage for the smaller things that usually aren't even worth going to the doctor for.
Posted by: J.D. Location: Sherman on Jun 26, 2008 at 04:27 AM
Hold your applause for the encore. This is only the tip of the iceberg. Just watch what comes down the "pipeline" about this time next year.
Posted by: Jeff Location: Bonham on Jun 25, 2008 at 10:08 PM
$537/month for coverage, up from $152 in 6 years, and Blue Cross of Texas is not doing right by me. Something is wrong here, care providers charge too much or Blue Cross has too much fat or maybe a little of both. The health care system and insurance seem to be colapsing under the weight of their own greed.
Posted by: Blue Cross Insurance Location: Colbert on Jun 25, 2008 at 10:08 PM
"They notified patients months ago about the change". This is the first I have heard about it. I have not received any information from the doctor's office or my insurance. I had my physical in Feb. and a follow-up in May, my husband had his physical in June and was never told anything about this. TMC's statement is not true or my doctor withheld information I should have known. Does anyone have anymore information on this.
Posted by: ra Location: fannin on Jun 25, 2008 at 10:04 PM
My husband and I both have BC/BS through work. My husband has had major medical trouble the past two years-two surgeries- BC/BS did pay for most of this--however, we did end up having to pay more than we thought we should have--more than our deductible and 20 percent copay. They do find ways not to pay. I don't understand because our family premium is almost 900 hundred a month. Looks they could negotiate a reasonable contract with the doctors. Makes me wonder who is being greedy--doctors or BC/BS?
Posted by: Anonymous on Jun 25, 2008 at 08:50 PM
another way to run good business out of town...
Posted by: Ticked Location: Sherman on Jun 25, 2008 at 08:23 PM
It's interesting that SO MANY people go through life without any insurance coverage, and those of us that are responsible enough to pay for it (and do without other things) pay the biggest price. It is wrong, but it's all about the money isn't it? Blue Cross continues to cut their benefit payments. I'm paying for nothing. We pay the premiums and much more on top of that!
Posted by: Anonymous on Jun 25, 2008 at 08:06 PM
I had heard a few months ago that Doctors in Gainesville were doing the same. They no longer take BCBS. Wouldn't you know I have BCBS too. I use to have BCBS of Michigan & never had a problem with them paying a claim.
Posted by: Insurance Poor Location: Sherman on Jun 25, 2008 at 08:06 PM
My children have seen a pediatrician from Denison for the past 13 years. I am saddened to say that today, after 13 years, I am transferring my children to a new doctor in Sherman. Leaving behind their pediatrician is hard for me, but especially hard for my kids. I believe that a corporation and an educated group of doctors should have been able to come to an agreement. It sounds to me like my children, as well as other BC/BS consumers, are caught in the middle. I hope these doctors, and TMC, realize that they will be losing thousands of patients..........and ALOT of money!
Posted by: AJ Location: Sherman on Jun 25, 2008 at 08:00 PM
Blue Cross Blue Shield doesn't care about the patient. They only care about making money for themselves.
Posted by: Linda Location: Sherman on Jun 25, 2008 at 07:23 PM
Gee, lets see...local doctors are dropping BCBS because they can't give the "quality of health care patients deserve." Well news flash... if my doctor drops my BCBS I WON'T HAVE ANY HEALTH CARE AT ALL as I cannot afford to pay out of pocket and certainly won't be driving toward Dallas. Also, due to pre-existing health issues it is unlikely I would be able to get another insurance to cover me. So much for doctor concern about their patients. How sad.
Posted by: TX Mom on Jun 25, 2008 at 07:18 PM
BCBS is not the only problem in this senario. Did anybody else have a problem with Texoma Care snatching up every decent doctor in the county and then doubling prices for an office visit?
Posted by: TX Mom on Jun 25, 2008 at 07:16 PM
All of the State of Texas employees are on this BCBS policy. If they don't get this worked out, everybody will be going to Dallas for medical.
Posted by: Bill Location: Texoma on Jun 25, 2008 at 06:21 PM
I hav blue cross blue shield from work and BC/BS takes in about $300 a month from me and you have your yearly deductibles, out of network etc every excuse they can figure out. I wish my employer would just pay me the money they pay BC/BS and I would be a lot happier. I would buy my own insurance. Blue Cross Blue shield is worthless.
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