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UT Southwestern/Texas Health Resources (UTSW/THR) Contract Negotiation with Amerigroup

Amerigroup will ensure continuity of care for 20,000 members

May 1, 2020

For many years, Amerigroup Texas members have been able to receive in-network medical care from UT Southwestern Medical Center and Texas Health Resources (UTSW/THR), which unfortunately has become one of the most expensive hospital systems in the state. Their high costs are making health care less affordable for our members at a time when health care affordability is more critical than ever. 

After nearly two years of contract negotiations, UTSW/THR has not provided timely, serious responses to Amerigroup’s proposals. It was our hope that a new agreement could be reached before June 1, 2020. This decision by UTSW/THR will affect more than 20,000 Amerigroup members, including individuals enrolled in our Medicare plans and some of the state’s most vulnerable and youngest Medicaid enrollees.

Amerigroup is taking steps to help our members make seamless transitions to new care providers and facilities, and we are launching a continuity of care plan for people with special health circumstances.

Why this is happening

Contractual relationships between an insurer and a hospital system involve periodic negotiations, and Amerigroup and UTSW/THR were in the process of negotiating a new contract to maintain the system’s in-network status for our members. 

UTSW/THR rates are some of the highest among all health systems in Texas. For example, the average cost per day in their facilities is 50 percent higher than our other in-network hospitals in north Texas and some of its rates are nearly two times the state Medicaid fee schedule. Furthermore, there is no accountability for quality written into the current contract.

UTSW/THR’s decision requires Amerigroup to send letters to notify our members of this possible disruption in their access to care. We remain willing to work with UTSW/THR to ensure patients have the care they need, when and where they need it. We hope UTSW/THR will join us in making that happen.

How Amerigroup is ensuring continuity of care for our members

Our members’ access to health care is our top priority. If UTSW/THR follows through on its intention to leave Amerigroup’s network, we will help our members make seamless transitions to new care providers and facilities. More than 60,000 providers across Texas are part of the Amerigroup network. In the region UTSW/THR serves, we recently welcomed three additional Baylor Scott & White health facilities to our network.

Amerigroup members affected by COVID-19 will continue to be covered. UTSW/THR hospitals must provide services for Amerigroup Texas members who require emergency care, including COVID-19, even if that health system becomes out-of-network.

For our members who have particular health circumstances that require continued access to UTSW/THR facilities, we will implement a continuation of care plan. An Amerigroup Medicaid member who began a course of treatment with UTSW/THR before June 1, 2020 may be eligible to keep receiving care there if he or she:

  • is in an active course of treatment for an acute medical condition, behavioral health condition, or serious chronic condition.
  • is pregnant, regardless of trimester.
  • has a terminal illness.
  • is a child between the ages of birth and 36 months.
  • has a surgery or other procedure that was authorized before June 1 and is scheduled within 180 days after the contract’s termination date.

In addition, Amerigroup Texas members will be able to access UTSW/THR providers and facilities for other exceptions, including the following: 

  • If a service is not available at an alternate participating provider, an Amerigroup Texas Medicaid member may request an out-of-network referral to see a UTSW/THR provider by contacting the Customer Service number listed on his or her ID card. Requests will be reviewed on a case-by-case basis, If Amerigroup approves the request, pursuant to Amerigroup’s Out-Of-Network Referral Policy, the consumer’s in-network benefit levels will apply.
  • Emergency care is always covered at in-network benefit levels. A hospital’s emergency medical services do not require pre-authorization, regardless of where they are delivered. UTSW/THR hospitals must provide services for Amerigroup members who require emergency care.

We know you have questions.

Try this Q&A document first.

If you still need information, Call Customer Services at the number on your Amerigroup ID card.

Need to find care near you? Use our mobile app or visit www.myamerigroup.com/tx to find doctors that are nearby and in your plan.