Last updated 9/16/2014
The expiring contract situation with Blue Cross Blue Shield of Georgia (BCBSGA) is a concern to all of us. This stressful situation is certainly not something Northeast Georgia Health System (NGHS) wants for you, the community, providers or our organization. We are disappointed by BCBSGA's actions that led to preparing the market to go out-of-network. We also realize many of you have heard incorrect information from Blue Cross, so we want to make sure you have the facts.
NGHS has worked tirelessly, since January, to come to an agreement with Blue Cross that is in the best interest of our patients and community for 2015. While Blue Cross has said publicly that it is committed to reaching an agreement, its actions prove otherwise:
- We were surprised on August 13, when Blue Cross invoked a "run-out period" that is specifically reserved for preparing the market to go out of network.
- We worked diligently to determine if this was indeed BCBSGA's intention. Blue Cross confirmed its intention and continued to pursue the run-out period.
- However, after August 13, Blue Cross publicly stated it wanted to continue negotiating, so NGHS spent additional days working to see if there was truly an opportunity for resolution. Unfortunately, BCBSGA's responses only put negotiations further behind.
Despite what Blue Cross says, it has made clear it is not willing to resolve this issue quickly – which we know is in the best interest of our community. BCBSGA's strategy is to continue saying "we're negotiating" through the Open Enrollment season to keep patients and employers from leaving the Blue Cross network. This keeps our community in limbo and leaves people in a disadvantaged position.
At this point, our negotiations with BCBSGA have ceased. The offer NGHS put on the table is fair and more than comparable with contracts NGHS has with other insurance companies that provide coverage options in this market. Based on BCBSGA's stalling and delays throughout the process, we have no confidence that it will work in good faith to come to a resolution for 2015 – are now forced to prepare our community for an inevitable contract termination.
Please read the frequently asked questions below for more information. We encourage you to keep this information in mind when choosing your healthcare insurance options during Open Enrollment, and we are here to help! If you have any other questions or would like to discuss your insurance options, please send us a message using the form on the side of this page or call 770-219-6610.
Click each question below to expand:
- When will my doctor's office and the hospital be out of network with Blue Cross Blue Shield?
Effective October 1, 2014, BCBSGA will drop many Northeast Georgia Health System (NGHS) providers and facilities from its network, which include:
- Northeast Georgia Physicians Group (most providers and locations)
- Patients who have Blue Cross HMO or POS plans and see primary care physicians at NGPG locations in Gwinnett and Forsyth counties are not affected. They can continue to receive care at those locations at in-network benefit levels after October 1, 2014.
- The Heart Center of Northeast Georgia Medical Center (all providers, all locations)
- Urgent Care (all locations: Gainesville, Braselton, Buford, Dawsonville)
- Northeast Georgia Physicians Group (most providers and locations)
Effective March 1, 2015, BCBSGA will drop Northeast Georgia Medical Center (NGMC) from its network along with the following NGMC facilities:
- The Imaging Center (all locations: Gainesville, Braselton, Dawsonville)
- The Rehabilitation Institute (all locations: Braselton, Buford, Cleveland, Dahlonega, Dawsonville, Gainesville)
- The Toccoa Cancer Center
- Hospice of Northeast Georgia Medical Center
- What health insurance plans are affected?
- This contract affects all BCBSGA and out-of-state BCBS members with a managed care insurance plan (HMO, PPO, POS, etc.).
- This contract does not affect any BCBSGA Medicare insurance plans (Medicare supplement, Medicare Advantage, Medicare State Health Benefit Plan, etc.).
- Patients have full, in-network access to care until the termination dates.
- Emergency services are always covered at in-network benefit levels, even if NGMC is no longer in the BCBSGA network.
- 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.
- I’m a teacher or state employee on the State Health Benefit Plan – what does this mean for me?
- Teachers in our service area on the State Health Benefit Plan have two insurance options for 2015 – BCBSGA and UnitedHealthcare. UnitedHealthcare will include Northeast Georgia Health System, Northeast Georgia Physicians Group and The Heart Center of Northeast Georgia Medical Center in its provider panel for 2015.
Click here to download a helpful PDF outlining your options for 2015.
- Do I have access to NGHS facilities and physicians now?
- Yes. We are still in-network with BCBSGA until the contracts expire. You can continue to receive care at NGMC at in-network rates between now and March 1, 2015. You can continue to receive care from NGPG and The Heart Center physicians between now and October 1, 2014.
- What if I have a procedure or doctor’s appointment scheduled after the contracts expire?
- During this time of transition, we will do everything we can to help you understand your rights, how your out-of-pocket costs may change for care and anything else we’re able to do under the law to help you with the cost of care. Our goal is to help make this a smooth transition for you and your family. If you have questions about an upcoming visit or procedure, please call 770-219-6610.
- What if I am pregnant or being treated for a chronic or terminal illness?
- There are certain patients who will be granted in-network status by BCBSGA after the termination dates because state law requires that their care be covered as an in-network benefit under Continuity of Care provisions. Patients who are hospitalized, pregnant or currently undergoing active treatment for an acute or chronic condition may qualify. NGHS will work with individual patients to help evaluate their Continuity of Care eligibility and opportunities to minimize or eliminate disruption in service.
- What if I need emergency care?
- Regardless of benefit plan, patients can always receive emergency care from NGMC. This is a covered benefit in every health plan whether you’re in-network or not.
- How long will NGMC, NGPG and The Heart Center be out of network with BCBSGA?
- Given the information we received from BCBSGA, you should make your new health insurance decisions based on these providers not being a part of the BCBSGA network in 2015.
- How does this affect physicians and providers with The Longstreet Clinic, Northeast Georgia Diagnostic Clinic, Specialty Clinics and other local physician practices in our community?
- The Longstreet Clinic, Northeast Georgia Diagnostic Clinic, Specialty Clinics and other independent physician practices in our community negotiate their own contracts with insurance companies such as BCBSGA, so their insurance contracts are not affected by our contract. However, these physicians are on staff at NGMC, so this affects their patients’ ability to access hospital services at NGMC at in-network rates after March 1, 2015.
- What other insurance plans does NGHS accept?
- NGHS has great relationships with most major insurance companies. For a complete list of in-network insurance carriers, visit our insurance page.
- Who should I call with additional questions?
- We are here to help. Please feel free to call our Managed Care office with questions at
Letter sent out on 8/22/2014
Northeast Georgia Health System (NGHS) is fortunate to have long-term relationships with many commercial insurance companies in our community. Unfortunately, there are rare circumstances when contracts end, and that's what is happening now with BCBSGA. This will affect patients' in-network access to our facilities and physician groups if they have BCBSGA managed care insurance.
Last week, BCBSGA exercised a contract provision that marked the end of our negotiations and started a "run out" period. The run out period is specifically designed to give the community time to evaluate other health insurance options or prepare for NGMC to be out of network in 2015. After the run out period, NGMC will be dropped from the BCBSGA network effective March 1, 2015. Additionally, NGPG and The Heart Center will no longer be part of the BCBSGA network effective October 1, 2014. This means that patients with a BCBSGA managed care insurance plan (HMO, PPO, POS, etc.) will no longer have in-network access to our facilities and the physician groups listed above. It is important to note that our contract does not affect any BCBSGA Medicare insurance plans (Medicare supplement, Medicare Advantage, Medicare State Health Benefit Plan, etc.).
Until the termination dates above, nothing changes. Patients still have full, in-network access to care at NGMC and with NGPG and The Heart Center physicians. After these termination dates, patients with BCBSGA managed care insurance will lose in-network access to specialty or elective services at NGMC and with NGPG and The Heart Center providers, or possibly face higher out-of-pocket costs. However, emergency services are always covered at in-network benefit levels, even if NGMC is no longer in the BCBSGA network. 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.
During this time of transition, we will do everything we can to help patients understand their rights, how out-of-pocket costs may change for care and anything we're able to do under the law to help with the cost of care. Our goal is to help make this a smooth transition for patients and their.
If you have questions about an upcoming visit or procedure, or if we can provide you with additional information or assistance, please don't hesitate to contact us at 770-219-6610. Also, below is a list of questions and answers that may be helpful to you.
We appreciate the confidence you have placed in our organization, and it is our desire to continue to serve you in the future.