Contract Standoff Could Push Ascension Seton Out of BCBSTX Network in Central Texas

Blue Cross and Blue Shield of Texas (BCBSTX) has issued a warning to its members that in-network access to Ascension Seton hospitals and clinics in the Austin area may be lost effective January 1, unless contract negotiations result in a successful agreement. This month, a notice was sent to certain policyholders that also pertains to Ascension Providence facilities in Waco.

“We are diligently striving to finalize an agreement; however, if we are unable to do so, Ascension hospitals will exit your network effective Jan. 1, 2026,” stated a postcard sent to members in Central Texas on Dec. 1.

The deadlock revolves around the insurer's agreements with Ascension regarding hospitals and facilities. In the absence of a new contract, the affected patients would include individuals enrolled in commercial BCBSTX plans, Medicare Advantage plans offered by the insurer, and those participating in Affordable Care Act exchange plans.

BCBSTX announced that some patients may still be eligible for “continuity of care,” which would allow them to access in-network rates despite Ascension's transition to out-of-network status. Eligibility is extended to pregnant individuals, people with disabilities, or those receiving treatment for acute or life-threatening conditions. Members are encouraged to call the number on their insurance card to confirm whether they meet the eligibility requirements.

The ongoing standoff reflects a series of recent contract disputes involving BCBSTX and various Texas health systems. In 2023, the insurer and Ascension finalized an agreement just ahead of a comparable deadline. In the previous year, BCBSTX and Baylor Scott & White Health reached an agreement following extensive negotiations.

A representative from BCBSTX stated, “Our goal is to protect our members’ and customers’ access to quality care at cost-effective rates.”

Ascension has stated that negotiations are still in progress and highlighted the importance of reimbursement that aligns with current financial challenges. “Ascension Texas has engaged in negotiations with BCBSTX for several months to obtain fair and market-relevant reimbursement for the essential healthcare services we offer,” stated the health system. “The terms of the contract proposed by BCBSTX fail to take into account the financial challenges faced by Ascension, as well as those impacting health systems nationwide, especially the significant rises in the costs of equipment and medications.”

According to the Texas Department of Insurance, BCBSTX stands as the largest insurer in the state, commanding approximately 25 percent of the Texas market. Ascension Seton manages a network of 12 hospitals across Central Texas, including Ascension Seton Medical Center Austin, Dell Seton Medical Center at the University of Texas, and Dell Children’s Medical Center, as well as numerous outpatient clinics and specialty practices.

Both organizations remain optimistic about reaching an agreement ahead of the deadline. Currently, patients are advised to stay informed and confirm their coverage status, given potential changes effective January 1.