Q&A About Changes in Coverage for Brenau Health Plan

Brenau University officials have been closely monitoring the impact of the recent decision of Hall County medical providers to drop out of the blue Cross-Blue Shield network that is used by a majority of the Brenau employees who participate in the university’s health insurance plan.

The following post, although lengthy, provides the latest information that is available, including news that Longstreet Clinic in Gainesville is an alternate provider that is covered by the university insurance plan.

“We are looking for alternative physicians for employees to use – like those with Longstreet – if their doctor becomes out-of-network,” said David Barnett, Brenau CFO. “We are requesting proposals from alternative insurance providers should the contract expire without resolution.”

Not all employees’ physicians will be considered out-of-network October 1, however. Only the physician’s practices owned and operated by NGHS in the local group are changing. Employees can contact their physicians or BCBSGA to determine if they will be out-of-network on October 1 if they are unsure.
Employees are still able to visit the NE GA hospital for emergency visits through March using their current insurance. They will still be able to visit the hospital when referred by an in-network doctor, too. It is only when they are using an out-of-network doc that they won’t be able to use the local hospital UNLESS they are receiving services for an ongoing problem that predates the expiration deadline and have requested and been granted approval by BCBSGA to continue treatment at in network charges.

According to Human resource Director Kelly Maddox, “We will continue to keep employees apprised as we learn new information. We are considering all options, and we estimate that we will have more information regarding the renewal within the next couple of weeks. Rest assured that, as soon as decisions are made, we will notify employees.”

Here is the Q&A provided by Northeast Georgia Health Systems:

BCBSGa is committed to continuing negotiations up to the expiration date and beyond, if necessary, to reach a mutually beneficial agreement with NGHS that includes fair, predictable, and sustainable contract terms that are in the best interest of our mutual health care consumers.

Please download the PDF for information about additional services provided by Longstreet Clinic and the Comprehensive Care Program. Download the PDF at http://update.brenau.edu/wp-content/uploads/formidable/Longstreet-Clinic-Info.pdf.

Northeast Georgia Health System – Contract Expiration Member’s Frequently Asked Questions:

Why are the contracts expiring?
The NGHS agreements with BCBSGa will expire for the HMO, POS, and PPO networks because the parties have been unable to reach agreement on new contracts. Unfortunately, if a new agreement is not reached before October 1, 2014, the physician group, NGPG, will be out-of-network. As of March 1, 2015, NEGAMC will be out-of-network.

What facilities are affected by the NEGAMC expiration?
Northeast Georgia Medical Center
NEGA Physicians Group-Urgent Care (Buford)
NEGA Physicians Group-Urgent Care (Dawsonville)
NEGA Physicians Group-Urgent Care (Gainesville)
Urgent Care of Braselton

What BCBSGa products/programs will be affected?
The following BCBSGa health plans will be affected: HMO, POS, and PPO.

I have a Blue Value Secure (Medicare Advantage HMO) plan. How will this affect my MA HMO benefits?
Neither NEGAMC nor NGPG are participating for this product so the expiration will not have any impact to Members with the Blue Value Secure product.

Does this expiration affect physicians?
Yes. The NGPG HMO, POS, and PPO Agreements will expire on October 1, 2014. In addition, physicians who do not have admitting privileges to another participating hospital, or an arrangement with a participating physician with privileges to handle admissions, will be unable to participate in the HMO, POS, and PPO networks as of March 1, 2015. You will face higher out of pocket costs when receiving services from an out-of-network physician. To check the network status of a physician, you should consult the “Find a Doctor” tool at bcbsga.com, or contact the Member Services number on the back of your Member Identification Card.

What are the alternative participating providers available to me?
BCBSGa offers a broad and comprehensive network of hospitals and physicians throughout Georgia providing you with access to quality health care providers. For a complete list of providers click on “Find a Doctor” at bcbsga.com or call the customer service number on the back of your Member Identification card.

What happens if I am an inpatient at one of the above NGHS facilities at the time of the expiration (March 1, 2015)?
If you are an inpatient on the date of the expiration, NEGAMC must continue to honor the contracted reimbursement rate until you are discharged from the hospital and your claim will be paid at the in-network level of benefits.

What are the other participating hospitals in the area?
All services available at NGHS hospitals are available elsewhere at participating hospitals. The nearest alternative participating hospitals are:

Hospital Address:
Athens Regional Medical Center, 1199 Prince Avenue, Athens, GA
Emory Johns Creek, 6325 Hospital Parkway, Johns Creek, GA
Gwinnett Medical Center, 1000 Medical Center Drive, Lawrenceville, GA
Habersham Medical Center, 541 US 441 Business, Demorest, GA
Northside Hospital – Forsyth, 1200 Northside Forsyth Drive, Cumming, GA
St. Mary’s Health Care System, 1230 Baxter Street, Athens, GA

Will I be covered for emergency care services at NGHS?
Yes. Emergency services at any appropriate facility or hospital, including NEGAMC, will continue to be covered in accordance with your benefit contracts and governing state and federal laws. You may be responsible for charges over your plan allowance in accordance with the terms of your benefit contract.

What happens if I go to an NGPG physician after October 1, 2014 or NEGAMC after March 1, 2015?
In order to receive the highest level of benefits for services, it is recommended that you consider the in-network providers in the area for your health care needs. If you are a POS or PPO member with out-of-network benefits and choose to utilize non-participating providers, your claim will be processed at the out-of-network benefit rate and the provider may balance bill you. That means you may owe the difference between our reimbursement and the provider’s higher charges. If you are an HMO member with no out-of-network benefits and choose to utilize a non-participating provider’s services, you will be responsible for the full costs of services you receive. In order to receive the highest level of benefits for any surgeries or procedures that you may have scheduled your physician should refer you to another participating provider in your network who can render the care at a participating hospital or facility. This will ensure that those services are covered at the highest possible level of benefit. In emergency situations, go to the nearest facility.

What if I am scheduled for a procedure or need to seek care at a NEGAMC facility before March 1, 2015?
You will continue to have in-network access to NEGAMC for all covered services until March 1, 2015. It is important to again note that emergency services will continue to be covered at in-network level of benefits; however, depending upon the terms of your benefit coverage, you may be subject to balance billing.

I want to avoid out of network costs. What if my physician typically admits his/her patients to NEGAMC hospital and doesn’t have admitting privileges to alternate BCBSGa participating hospitals?
You should talk to your physician about other options. Many physicians have admitting privileges at more than one hospital. Physicians, who admit only to NEGAMC, and do not have an arrangement with a participating physician with privileges to handle admissions to another participating hospital, will be unable to participate in the BCBSGa networks.

Is there a continuation of care period?
Continuation of care benefits are available for physician services. If you currently receive care from a physician whose contract expires on October 1, 2014, you may be eligible for continuity of care benefits from your physician. These benefits enable you to continue NGPG physician services at in-network benefit levels for a limited time following the expiration. To be eligible, you must be in active treatment for a specific medical condition. You can obtain the form to request such continuity of care at bcbsga.com or by calling the Member Services number on the back of your Identification Card.

The continuation of care period for hospital services only applies if you are an inpatient on March 1, 2015, the date of expiration. In this instance, your claim will be paid at an in-network level of benefits and you will be protected from any balances over your plan allowance through the date of your discharge from NEGAMC.

Why can’t BCBSGa reach an agreement with NGHS?
We recognize the importance of this health system to you and your family. For this reason, we will continue to work hard to negotiate an agreement that is reasonable, fair, predictable, and sustainable and at rates that will not force health care costs to increase substantially for our employer groups and you, our members. Unfortunately, we have been unable to reach such agreement. We remain available to continue contract negotiations and achieve a mutually beneficial agreement.

Why did BCBSGa cease contract negotiations with NGHS?
BCBSGa did not cease contract negotiations with NGHS. The NGPG physician contracts are scheduled to expire effective October 1, 2014 if the parties do not reach agreement on new contracts prior to October 1, 2014. BCBSGa remains committed to negotiate an agreement that is reasonable, fair and competitive and at rates that will not force health care costs to increase substantially for our employer groups and you, our members.

Is this about increasing profits for BCBSGa?
No. BCBSGa would like to renew NGHS as a contracted in-network provider. BCBSGa is Georgia’s leading health insurer, and has been proudly providing access to quality, affordable health care for over 75 years. Our members remain our top priority.