Patients with health insurance through BlueCross BlueShield Georgia hang in limbo as the insurance company and Northeast Georgia Health System head toward contract deadlines.
If the two can’t come to an agreement, these patients will no longer have in-network access to Northeast Georgia Medical Center and physicians employed by NGHS.
The health system has announced that the insurance company issued notification of a run-out period for its contracts.
BlueCross BlueShield said there are two contracts at issue. One that pertains to physicians associated with NGHS expires Oct. 1, while a separate contract between BlueCross BlueShield and the hospital has been extended to March 1, 2015.
“BlueCross and BlueShield of Georgia Inc. and BlueCross BlueShield Healthcare Plan of Georgia Inc. has been negotiating in good faith with Northeast Georgia Health System since January of this year, BlueCross BlueShield spokesman Tony Felts said. “In fact, agreement has been reached on numerous aspects of the contract, including many of the reimbursement terms. Significant progress has been made. That’s why we were surprised to learn Northeast Georgia Health System has chosen to allow the contract to expire.
“It’s important to note that there are several weeks before the deadline, and we are committed to reaching an agreement,” he said.
The Oct. 1 deadline refers to Northeast Georgia Physicians Group and the Heart Center of Northeast Georgia Medical Center, meaning patients with a BlueCross BlueShield Georgia managed-care insurance plan will no longer have in-network access to those facilities.
Melissa Tymchuk, director of public relations with the health system, said the contract expiration does not affect any BlueCross Blue Shield Georgia Medicare insurance plans, including Medicare supplement, Medicare Advantage and Medicare State Health Benefit Plan.
“We are fortunate to have long-term relationships with many commercial insurance companies in our community,” she said. “Unfortunately, there are some instances when contracts end, and that’s what is happening with (BlueCross BlueShield Georgia).”
Felts said the insurance company exercised a provision in the existing contract that keeps the hospital in network until March 1.
“We did this to reduce uncertainty for our members,” he said. “NGHS could have invoked this provision as well, but did not.”
According to Tymchuk, after negotiating since January, including a deadline extension, talks ended last week when the insurance company sent a notice beginning a “run-out” period, which is designed to give the community time to evaluate other health insurance options or to prepare for the hospital to be out of network in 2015.
“This language is in place to ensure we come to an agreement or know for sure about a contract expiration in early fall, before the traditional time of open enrollment and in advance of the expiration date, so that patients can be certain of their in-network access to NGMC when evaluating choices for insurance coverage for 2015,” Tymchuk said.
“After several efforts to confirm that BCBSGA was not willing to come to a satisfactory agreement before entering into the run out period, we had no option but to move forward with notifying our affected audiences of the contract expiration dates.”
Felts, however, said the insurance company still hoped to reach a new agreement with NGHS.
“For NGHS to say this means BCBSGa is not interested in continuing talks is not accurate,” he said. “We are committed to continuing negotiations up to the expiration date and beyond, if necessary. We encourage NGHS to come back to the negotiating table, where we stand ready to negotiate fair and sustainable contract terms that are in the best interest of our mutual health care consumers.”
Emergency services are always covered at in-network benefit levels, even if the hospital is no longer in the BlueCross BlueShield of Georgia network, according to the health system. Additionally, patients who are pregnant or being treated for chronic or terminal illness may qualify for continuing in-network status even after the contract termination dates.
“We are in the process of contacting affected patients now. During this time of transition, we will do everything we can to help make this a smooth process for patients and their families,” Tymchuk said.
Patients can direct questions to a dedicated phone line, 770-219-6610, or visit www.nghs.com/blue-cross.
The insurance company said it also is working to ensure a smooth transition for patients.
“If a new contract is not reached by the deadline, BCBSGa will work with affected members to find them alternatives for cost-effective, quality care in BCBSGa’s network of more than 28,000 medical professionals and 180 hospitals,” Felts said.