Southwestern Health Resources Contract Negotiations Frequently Asked Questions

04/02/2025

What is happening between Blue Cross and Blue Shield of Texas (BCBSTX) and Southwestern Health Resources (SWHR) providers and hospitals?

BCBSTX and SWHR have been negotiating a new contract, which is a standard process between health insurance companies and providers. The current contract expired March 31, 2025. BCBSTX values its long relationship with SWHR and continues to work closely with them to reach an agreement.

Since an agreement is not reached, their providers and facilities no longer participate in the provider network for the HealthSelect of Texas and Consumer Directed HealthSelect medical plans as of April 1, 2025.

BCBSTX will continue discussions with SWHR in hopes of reaching an agreement. ERS is closely monitoring the negotiations.

What information is important for me to know?

SWHR providers have left the HealthSelect network as of April 1, 2025, but you still have access to other high-quality in-network hospitals, doctors and other health care providers across Texas. For help locating in-network providers, you can contact a BCBSTX Personal Health Assistant at (800) 252-8039 (TTY:711), Monday-Friday 7 a.m.-7 p.m. and Saturday 7 a.m.-3 p.m. CT.

If you have a valid referral or authorization on file to a SWHR specialist who is no longer in the network, you will be able to continue care at the in-network level of benefits for up to 30 days or the end of your current approved referral or authorization, whichever comes first. If your SWHR PCP is no longer in the network, but your specialist remains in your network, your referral will be valid through the referral's expiration date.

If you are currently being treated for a serious and complex condition or are undergoing institutional or inpatient care and have not received an updated authorization for continuity of care from BCBSTX, please contact a BCBSTX Personal Health Assistant at (800) 252-8039 (TTY:711) Monday-Friday 7 a.m.-7 p.m. and Saturday 7 a.m.-3 p.m. CT.

If you have submitted a request for continuity of care and have not received an updated authorization from BCBSTX yet, please know we are working on it. A BCBSTX Personal Health Assistant can help you understand your authorization status.

If you aren't eligible for continuity of care and want to continue seeing SWHR providers even if they're no longer in the HealthSelect network, your HealthSelect plan will cover care by SWHR providers at the out-of-network level. You will pay more out of pocket for out-of-network services.

We understand how important it is to have high-quality, affordable health care in your area. BCBSTX Personal Health Assistants are ready to help you understand your options and ensure you have access to the care you need.

In addition to answering questions about continuity of care, a BCBSTX Personal Health Assistant can:

  • confirm if your provider is impacted by this negotiation,
  • work with you to select a new primary care provider, or to get new referrals and authorizations to in-network providers for services that do not qualify for continuity of care benefits and
  • assist with any other questions or concerns you may have.

What if I don’t have a current authorization on file, but think I may qualify for continuity-of-care benefits?

The HealthSelect medical plan may allow you to continue to receive services from SWHR providers at the in-network benefit level, under certain conditions. This is called continuity of care, and it could continue for a certain timeframe, as required by state or federal law.

You should submit a Continuity of Care Request form. A BCBSTX Personal Health Assistant can also help you with the request form or answer any questions you may have about the form.

My primary care provider (PCP) is an SWHR provider. Do I need to change my PCP?

HealthSelect medical plan participants have many options for PCP care. You will be able to continue seeing your PCP during a 30-day grace period. Following the grace period, you will need to choose a new in-network PCP.

If you need to see an in-network specialist during the grace period, you are still required to have a valid referral on file with BCBSTX prior to receiving care from that specialist. You will need to select an in-network PCP to obtain a referral.

Please contact a BCBSTX Personal Health Assistant at (800) 252-8039 (TTY:711) Monday-Friday 7 a.m.-7 p.m. and Saturday 7 a.m.-3 p.m. CT for help locating in-network PCPs.

You can also communicate via secure chat and secure messaging Monday-Friday, 8 a.m.-5 p.m., after logging in to Blue Access for MembersSM.

I have questions about the letter and/or postcard I received in the mail. Who do I contact?

If you got a postcard and/or letter in the mail about the negotiations between BCBSTX and SWHR, it’s probably because you and/or your covered dependent(s) received care from a SWHR provider within the past 12 months.

If you have questions about anything you get in the mail from BCBSTX, please contact a BCBSTX Personal Health Assistant at (800) 252-8039 (TTY:711) Monday-Friday 7 a.m.-7 p.m. and Saturday 7 a.m.-3 p.m. CT.

¿Podré seguir accediendo a las salas de emergencia de SWHR?

Yes. In the case of an emergency illness or injury, you should go to the nearest acute care emergency facility. As a HealthSelect medical plan participant, you should not be billed for any amounts above the participant responsibility for deductibles, copays and coinsurance for emergency care.

How can I locate other providers in the HealthSelect network?

HealthSelect medical plan participants in Texas can still access in-network hospitals, doctors and other health care providers throughout the state.

To find providers in the HealthSelect network, you can visit healthselectoftexas.com and click “Find a Doctor/Hospital” or log in to your Blue Access for Members account. You can also call a BCBSTX Personal Health Assistant at (800) 252-8039 (TTY:711) for help finding in-network providers. You can also communicate via secure chat and secure messaging Monday-Friday, 8 a.m.-5 p.m., after logging in to Blue Access for Members.

Note: HealthSelect medical plans include benefits to receive care from out-of-network providers. If you choose to receive care from out-of-network providers, you may pay more out-of-pocket – sometimes a lot more.