GAINESVILLE, Ga. – Northeast Georgia Health System announced today that Blue Cross Blue Shield of Georgia (BCBSGA) has issued notification of a run out period for its managed care contracts with NGHS, which means patients soon will no longer have in-network access to Northeast Georgia Medical Center (NGMC) and physicians employed by NGHS.
According to Melissa Tymchuk, director of Public Relations, NGMC will be dropped from the BCBSGA network effective March 1, 2015. Additionally, Northeast Georgia Physicians Group (NGPG) and The Heart Center of Northeast Georgia Medical Center (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 NGMC facilities and these physician groups. Tymchuk emphasized that the contract expiration does not affect any BCBSGA Medicare insurance plans, including Medicare supplement, Medicare Advantage, Medicare State Health Benefit Plan, etc.
“We are fortunate to have long-term relationships with many commercial insurance companies in our community,” says Tymchuk. “Unfortunately, there are some instances when contracts end, and that’s what is happening with BCBSGA.”
According to Tymchuk, after negotiating since January of this year, including a deadline extension, talks ended last week when BCBSGA sent a notice beginning a “run out” period. The run out period is designed to give the community time to evaluate other health insurance options or to prepare for NGMC to be out of network in 2015. The contract states that the run out period is “to provide for an orderly transition for all affected patients and providers; such extension shall not be initiated for the purpose of continued negotiations.”
“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 says. “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.”
According to Tymchuk, until the respective termination dates, 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 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. NGHS is also proactively working with BCBSGA to take other steps to ease the transition, Tymchuk said.
“We 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. We encourage patients who have questions to call our dedicated phone line, 770-219-6610, or visit our website at www.nghs.com/blue-cross.”
Effective March 1, 2015, Blue Cross and Blue Shield of Georgia (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 and Oakwood)
- The Toccoa Cancer Center
- Hospice of Northeast Georgia Medical Center
Effective October 1, 2014, BCBSGA will drop Northeast Georgia Health System providers and facilities from its network, which include:
- Northeast Georgia Physicians Group (all providers, all locations)
- The Heart Center of Northeast Georgia Medical Center (all providers, all locations)
- Urgent Care (all locations: Gainesville, Braselton, Buford, Dawsonville)
Get the latest information about NGHS' relationship with BCBSGA, and answers to frequently asked questions, at www.nghs.com/blue-cross.