Update on Your Health Plan’s NetworkMarch 13, 2018
Piedmont Healthcare, Inc. and Piedmont Clinic Physician Practices (collectively “Piedmont”) could be leaving your network April 1, 2018.
We’re currently working hard to reach a new “in-network care provider” agreement with Piedmont before our contract with them expires on April 1, 2018.
- There’s no change yet
But, if we’re not able to agree on a new contract, Piedmont (with the exception of Piedmont Rockdale Hospital and Piedmont Columbus Regional) will no longer be an in-network care provider with Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. (collectively “BCBSGa”) starting April 1, 2018. This will mean any claims starting April 1, 2018, for all care provided by Piedmont, will be considered out-of-network and reimbursed as out-of-network under the terms of your health plan.
- Our long history of partnership with Piedmont gives us hope
We’re working hard to come to an agreement that continues to give you access to affordable care — and also makes sure that Piedmont is compensated fairly. Our members are our top priority, so we’re hoping to sign a contract soon so you can continue to get in-network care from Piedmont.
- Need more information?
Read over some common questions and answers below. If you have other questions or to get help finding a doctor or hospital, you can call the Member Services number on your BCBSGa ID card. For a complete list of care providers, log on to bcbsga.com and select Find a Doctor.
- Continuity of Care
If you have services or a procedure scheduled at/with one of the Piedmont hospitals, facilities or care providers (with the exception of Piedmont Rockdale Hospital and Piedmont Columbus Regional), you may be eligible for Continuity of Care. It’s called Continuity of Care because it allows you to continue to get certain care at Piedmont — and we’ll treat it as in-network. It’s only for specific medical or behavioral health conditions for a defined period of time. And it’s only if there are medical reasons that would prevent you from having your care immediately transferred to an in-network care provider.
- Examples of medical or behavioral health conditions that may qualify for Continuation of Care
- Completing a course of treatment
- In an active course of treatment for cancer
- Pregnant (any trimester)
- Being treated for a terminal illness; Hospice Care
- Undergoing transplant care or waiting for a transplant
- Being treated for a serious medical or behavioral health condition
- Some conditions that don’t qualify for Continuation of Care include but are not limited to:
- Routine exams, vaccinations and health assessments
- Ongoing conditions you may have but are able to manage well such as diabetes, arthritis, allergies, depression, asthma, hypertension (high blood pressure) and glaucoma
- Elective (non-urgent) inpatient and/or outpatient surgery
- If you think you might be eligible, call us right away
We’ll confirm whether you’re eligible. And then you can work with your doctor to fill out the Continuity of Care form. You can download the Continuity of Care form or you can call the Member Services number on your BCBSGa ID card to get a copy mailed or emailed to you.
- When you fill out the form:
- Please answer all questions completely. To help us review your form quickly, please return it as soon as possible.
- Section 1 and 2 need to be completed by the patient. If the patient is a minor, a guardian’s signature is required.
- Section 3 is completed by the treating care provider.
- The treating care provider should fax the completed form to Medical Management at 1-877-254-4971.
If you need ongoing care for a worsening condition and do not require a special course of treatment, you’ll need to choose an in-network care provider to meet your ongoing health care needs. And you do not need to complete this form.
- What will happen once we receive your completed form?
We’ll review it and let you know if you can continue your care with the hospital, facility or care provider and still receive in-network benefits, or if you have to change to an in-network care provider. If you have to change care providers to get in-network benefits, we’ll help you find a hospital or facility that fits your needs.
- Questions and Answers
Q: How can I stay up-to-date on Piedmont’s status?
A: For the most up-to-date information refer back to this site at bcbsga.com/piedmont or call the Member Services number on your BCBSGa ID card.
Q: What are BCBSGa and Piedmont talking about in your discussions about the contract?
A: Contract discussions are a standard, normal and routine part of what we do. Our goal is to come up with a contract that gives you the best access to affordable care, while also ensuring that we’re paying care providers and hospitals fairly.
Q: When does the contract with Piedmont end? What does this mean to me?
A: There is no immediate change to your health care coverage. Piedmont and its care providers remain in-network until April 1, 2018. And it’s our hope to have a new contract in place by then. If we’re not able to agree on a new contract, Piedmont (with the exception of Piedmont Rockdale Hospital and Piedmont Columbus Regional) will no longer be an in-network care provider with BCBSGa beginning April 1, 2018. This will mean any claims for services received from Piedmont on or after April 1, 2018, will be considered out-of-network.
Q: What Piedmont facilities and practices would be affected by this?
A: Piedmont Clinic Physician Practices, Piedmont Hospital (Atlanta) Piedmont Athens Regional Medical Center (Athens), Piedmont Fayette Hospital (Fayetteville), Piedmont Henry Hospital (Stockbridge), Piedmont Mountainside Hospital (Jasper), Piedmont Outpatient Center at East Ellijay, Piedmont Newnan Hospital (Newnan), Piedmont Newton Hospital (Covington), Piedmont Imaging/Diagnostic Centers, Piedmont Ambulatory Surgery Centers, Piedmont Urgent Care Centers. Piedmont Rockdale Hospital and Piedmont Columbus Regional are NOT impacted by the outcome of our contract talks at this time. That means they will continue to be an in-network hospital.
Q: Would Piedmont doctors be affected, too?
A: As of April 1, 2018, doctors who are part of Piedmont Clinic and doctors who only admit to Piedmont Hospitals and do not have admitting privileges to another in-network hospital will not be in your network. You’ll face higher out-of-pocket costs when receiving services from an out-of-network doctor or at an out-of-network facility. To check if a doctor or hospital is part of your plan’s network, log in to bcbsga.com, or call the Member Services number on your BCBSGa ID card.
Q: What products/plans are affected by these contract talks? What happens if I go to Piedmont or a Piedmont affiliated doctor on or after April 1, 2018?
A: All of the BCBSGa networks that are currently contracted with Piedmont are affected. This includes the network for the State Health Benefit Plan.
- POS and PPO: If Piedmont is no longer in our network on or after April 1, 2018, you’ll need to use an in-network care provider for non-emergencies to receive in-network benefits under your plan. If you choose to see an out-of-network care provider, you will have to pay much higher costs. And, the care provider can bill you if there is a difference between what we reimburse them for your claim and the amount they charge you.
- HMO: If Piedmont is no longer in our network on or after April 1, 2018, you’ll need to use an in-network care provider for non-emergencies to receive benefits from your health care coverage. If you choose to see an out-of-network care provider, the care provider can bill you if there is a difference between what we reimburse them for your claim and the amount they charge you.
- Medicare Advantage HMO: A dedicated Medicare customer service team is available from 8 a.m. to 8 p.m. ET, seven days a week. Please call 1-866-438-9968 or 1-877-247-1657 for TDD/TTY.
Q: What do I need to do?
A: You may not need to do anything at all if we’re able to reach an agreement with Piedmont. If we don’t, you still don’t have to do anything unless you:
- Are under treatment with any of these hospitals, facilities or care providers after they change from participating to non-participating,
- Are scheduled for treatment at/with any of these hospitals, facilities or care providers after they change from participating to non-participating,
- Have questions about your coverage, or
- Need help accessing services in Anthem/BCBSGa’s networks.
If any of these situations apply to you, please call the Member Services number on your BCBSGa ID card.
Q: Will I be covered for emergency care services at Piedmont?
A: In an emergency, you should always go to the nearest emergency room. Emergency services, including those received from Piedmont, will continue to be covered according to your benefit contract and governing state and federal laws. You may be responsible for charges over your plan allowance based on the terms of your benefits.
Q: I want to avoid out-of-network charges. Who else can I see for care? What are the alternative in-network care providers available to me if a new agreement isn’t reached?
A: BCBSGa offers a broad network of choices in health care. For a complete list of care providers, use Find a Doctor or call the Member Services number on your BCBSGa ID card.
Q: What happens if I am an inpatient at Piedmont at the time they leave the network?
A: If you’re an inpatient on April 1, 2018, Piedmont must continue to honor our in-network reimbursement rate until you are discharged from the hospital, and your claim will be paid at the in-network level of benefits.
Q: What if I am currently in active treatment at Piedmont or have a procedure scheduled? Do I have to change?Q: Will I have to change my PCP?
A: If you have services or a procedure scheduled at/with one of the Piedmont hospitals, facilities or care providers listed above, you may be eligible for continuity of care, which means you would not need to change your appointment.
A: If your PCP is a Piedmont physician you will want/need to change your PCP. If you do not select a PCP, a PCP will be assigned for you. You may receive a letter indicating your PCP has terminated. We can assist you in changing your PCP.
Q: I’m a transplant patient at Piedmont. Will I be impacted by this?
A: BCBSGa Medical Management will be outreaching to and working with each transplant patient during this time. If you have been approved for transplant and are on the waiting list, you will not be impacted. If you are in the evaluation phase and you are not yet on the waiting list, BCBSGa Medical Management will work with you to assess your current status and ensure you a smooth process.