When Michelle Cook received a call from her primary care physician’s office Wednesday urging her to move an annual physical up two weeks earlier than scheduled, she was taken by surprise.

She was told that if she didn’t have her preventive care visit completed before the end of March — before the April 6 date she had originally planned — she might not be able to get it done at all, at least, not at that physician’s office. Or she might have to pay the full cost, out-of-pocket.

Cook’s primary care doctor is part of Texas Health Resources, one of North Texas' largest provider groups. But Texas Health is in yet another dispute with the state’s largest health insurer, Blue Cross and Blue Shield of Texas, over a 15-month contract that is slated to end on March 31.

Déjà vu all over again

It’s déjà vu all over again for consumers like Cook, a retiree in Denton County who, like many, watched the two companies go through a similar stalemate at the end of 2016. That dispute threatened to leave more than 150,000 in a scramble to find new doctors. But a new deal was signed in the final hour that year.

Just over a year later, anxiety is again mounting as the new deadline approaches and consumers rush to prepare.

“I’ve been calling for hours on end,” said Brian Nowlin, a customer service agent in Rockwall who suffers from migraines and back pain. He’s supposed to get treatments in early April, but his care will be delayed if he has to find a new doctor and get a brand new referral next month.

“No one is giving definite answers. On a scale of one to 10, my frustration level is 10,” he said.

Likewise, Cook said she has a long-established relationship with her primary-care doctor. “But we are on an HMO and have no other choice if there isn't an agreement,” she said. And she’s at her wits’ end with how insurer-provider contract deals play out publicly, leaving thousands in limbo.

“It’s one thing to do it at the end of the year when we’re shopping for health insurance. But to do it mid-cycle, outside of the sign-up period, leaves our hands tied,” she said.

“It's like a giant game of ‘chicken’ that THR and BCBS are playing, waiting to see who blinks first, with the greatest stress landing on the patients and physicians,” she added, referring to both companies as “bullies.”

Finger-pointing

A doctor’s office alerted Cook to the dispute. But in late February, Blue Cross began mailing postcards to local members that had visited Texas Health Resources doctors over the past year.

The state's largest health insurer, Blue Cross and Blue Shield of Texas, and one of the region's largest provider groups are in yet another dispute over a contract that could come to an end on March 31, 2018. Blue Cross of Texas began alerting consumers via a flyer in the mail in February.

About 75,000 households have received the cards to date, which represents more than 185,000 members, Blue Cross said. A microsite for members was set up about the "potential" disruption.

Contract negotiations are still underway, but in a video posted online, Dr. Paul Hain, the company’s North Texas Market president, made it sound like the contract ending was a done deal.

“Despite our best efforts, we have not reached an agreement with THR. So starting on April 1, their facilities will no longer participate in Blue Cross and Blue Shield networks in Texas,” he said.

In a phone interview, Hain justified the language.

“We want people to be prepared. It’s important that we don’t underplay it,” he said, adding that the payment increases that Texas Health has requested could potentially raise rates significantly for both employer-based and commercial health plans.

In a statement, Texas Health expressed disappointment over Blue Cross' comments to members about the ongoing negotiations, calling them “unfortunate, but not surprising.”

“Their inaccurate and misleading claims are polarizing and distracting everyone from the mission at hand, which is about our organizations coming together to ensure uninterrupted care for thousands of North Texans. We remain optimistic and focused on reaching a fair agreement that is in the best interest of our patients, providers and employers,” the statement received Friday said.

Consumer protections

Cook was able to reschedule her blood work and annual physical to the last week of March, "just squeaking in if the negotiations do fall apart," she said. However, her husband's medical visit had to be canceled altogether, because he won't be due for his next physical exam until April.

If history is any predictor, a deal will be reached and the hoopla will have been unnecessary.

But until contract renewal papers are signed, there are no guarantees. And if the worst does happen, here are some things consumers should know from the last time contract negotiations went down to the wire.

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