PPO Policy Changes For BlueCross BlueShield Of Texas

PPO Policy Changes For BlueCross BlueShield Of Texas

Changes are coming to health insurance plans in 2016. BlueCross BlueShield of Texas will no longer offer individual Preferred Provider Organization or PPO insurance plans.

The change will impact about 5,000 to 7,000 regional residents, according to Wichita Falls insurance advisers.

However, not everyone that has PPO plans is impacted by the switch. The changes do not affect plans that are grandfathered in. Plans are considered grandfathered in if they were purchased before March 23, 2010, before the Affordable Care Act became law.

The changes will also not affect group PPO plans, the federal group BlueCross BlueShield plans, and will not impact Medicare supplement plans. Those that purchased the individual PPO plans, that are affected, will soon have to convert to Health Maintenance Organization or HMO plans.

 “First of all, don't panic,” said Kelly Fristoe, Regional Vice President of the National Association of Health Underwriters. “We have until December 31st to make some decisions for our January first coverage.”

The main difference in coverage will result in a smaller in-service network. There are only 11 primary care physicians in the immediate area. Those physicians span Archer City, Wichita Falls, and Burkburnett.

Policy holders will first have to see a primary physician in order to be referred to specialty doctors.

“It's very important that they, the consumers, seek out their advice and counsel as it comes to enrolling and understanding the details moving forward,” said Fristoe.

The main concern is that United Regional is not currently in the HMO coverage plan. However, Kell West is. In any life threatening, emergency situations the insurance coverage has to be accepted at any hospital, according to Fristoe.

While United Regional will not be in the HMO network, they are willing to work with those using the new policy.

“For elective procedures, United Regional will contact BlueCross BlueShield of Texas to determine if the procedure may be covered by the HMO due to medical necessity and/or lack of adequate network coverage,” said Phyllis Cowling, President & CEO United Regional Health Care System.

 This will be done prior to any elective procedures, according to Cowling.

“In 2014, over 90-percent of BCBSTX patients seen at United Regional were covered under a group plan (or Medicare Advantage) and are not affected by this change,” said Cowling.

BlueCross BlueShield of Texas will offer an additional HMO plan called HMO plus. It will be a more expensive option but will provide some other options as far in-service networks.

Another option for those impacted by the changes would be adding other family members to current group PPO plans, purchased through employers.

There are a few other coverage options available for residents in the area. United Health Care Systems and Humana HMO plans will also be available.

Rates will not be available for consideration until the exchange opens on November 1, 2015. Policy holders have until December 31, 2015 for January 1st coverage.

 If you are impacted by the changes you can start looking up primary care physicians near you. All you have to do is head to the BlueCross BlueShield website.


  1. style="margin-top:0in;margin-right:0in;margin-bottom:0in;margin-bottom:.0001pt;text-autospace:none;">Click “find a doctor with provider finder” then pick Texas and click start search.
  2. style="margin-top:0in;margin-right:0in;margin-bottom:0in;margin-bottom:.0001pt;text-autospace:none;"> Make sure “plan networks” is selected.
  3. style="margin-top:0in;margin-right:0in;margin-bottom:0in;margin-bottom:.0001pt;text-autospace:none;"> Then, in the drop down box, make sure Blue Advantage [BAV]
  4. style="margin-top:0in;margin-right:0in;margin-bottom:0in;margin-bottom:.0001pt;text-autospace:none;">Then you can search by name, city or zip code, to find a provider in your are

Brittany Costello, Newschannel 6