Piedmont may leave BlueCross network April 1, 2018
BlueCross BlueShield of Georgia is currently working hard to reach a new “in-network care provider” agreement with Piedmont before their contract expires on April 1, 2018.
There’s no change yet
If BlueCross is not able to agree on a new contract, Piedmont (with the exception of Piedmont Rockdale Hospital) 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.
Long history of partnership with Piedmont gives us hope
This isn't the first hospital system and insurance company who have been involved in last-minute contract negotiations. Because of the long standing partnership between Piedmont and BlueCross, we are hopeful that a contract soon to keep Piedmont as an in-network provider.
Need more information?
Download his helpful FAQ about the Piedmont/ BlueCross network negotiations, which was published on the BlueCross BlueShield website.
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), 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 BlueCross will treat it as in-network. It’s only for specific medical and 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 conditions that may qualify for Continuation of Care
Completing a course of treatment
In an active course of treatment for cancer
In your 2nd or 3rd trimester of pregnancy
Being treated for a terminal illness; Hospice Care
Undergoing transplant care or waiting for a transplant
Being treated for a serious medical 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, asthma, hypertension (high blood pressure) and glaucoma
Elective (non-urgent) inpatient and/or outpatient surgery
If you think you might be eligible, contact BlueCross right away
There will be an approval process at BlueCross to confirm whether you’re eligible or not. And then you can work with your doctor to fill out the Continuity of Care form.
You can download the Continuity of Care form here.
When you fill out the form:
Please answer all questions completely. To help BlueCross 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.
Contact your service representative at Rick Bailey & Company will any questions about this process.
What will happen once we receive your completed form?
BlueCross will 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.
Rick Bailey & Company will keep you informed of changes
Rick Bailey & Company will be there to keep you updated, every step of the way. Follow us on Facebook or check back on our Blog for the most current insurance information.