Update on Your Health Plan’s Network: Hospital Corporation of America (HCA)October 01, 2018
Effective October 1, 2018, Hospital Corporation of America (HCA) is no longer an in-network care provider with Blue Cross and Blue Shield of Georgia.
How does this affect you?
This means any claims starting October 1, 2018, for all care provided by HCA, will be considered out-of-network and reimbursed as out-of-network under the terms of your health plan.
We’re continuing to work hard to come to an agreement that continues to give you access to affordable care — and also makes sure that HCA is compensated fairly. Our members are our top priority, so we’re hoping to sign a contract soon so you can continue to get in- network care from HCA.Why Is This Happening?
A health plan is nothing without skilled doctors, nurses and facilities to care for you and your family. These are critical partnerships we can’t do without. Our job is to find the right balance between providing access to providers and the cost of accessing those providers. We continue to work with HCA to find that proper balance.
We help manage costs in many ways. One is by covering preventive services that help avoid or detect major issues. Like annual check-ups, for example. With most of our plans, we pay for the entire cost because we know they help our members stay healthy.
Another important piece is partnering with thousands of doctors, hospitals and specialists across the country on what they will be paid for each and every health care service. Remember, the money we pay to hospitals and doctors comes directly from your monthly payments. The more we pay as a health plan, the more we all pay as consumers.
It’s important to try and provide predictable pricing for health services as unpredictable costs significantly impact affordability and access. At Blue Cross and Blue Shield of Georgia, we believe in compensating hospitals and doctors fairly and any payments we make on behalf of our consumers properly reflects the level of care and quality provided at these facilities.Continuity of Care
If you have services or a procedure scheduled at/with one of the HCA hospitals, facilities or care providers on or after October 1, 2018, 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 HCA — and we’ll treat it as in-network. It’s only for specific medical or 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 or behavioral health conditions that may qualify for Continuation of CareIf you’re:
- Completing a course of treatment
- In an active course of treatment for cancer
- Pregnant (any trimester)
- Being treated for a terminal illness; Hospice Care
- Undergoing transplant care or waiting for a transplant
- Being treated for a serious medical or behavioral health 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, depression, asthma, hypertension (high blood pressure) and glaucoma
- Elective (non-urgent) inpatient and/or outpatient surgery
If you think you might be eligible, call us right away
We’ll confirm whether you’re eligible. And then you can work with your doctor to fill out the Continuity of Care form. You can download the Continuity of Care form or you can call the Member Services number on your BCBSGa ID card to get a copy mailed or emailed to you.
When you fill out the form:
- Please answer all questions completely. To help us 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.
What will happen once we receive your completed form?
We’ll 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. If you have to change care providers to get in-network benefits, we’ll help you find a hospital or facility that fits your needs.
Frequently Asked Questions
Q: How can I stay up-to-date on HCA’s status?
For the most up-to-date information refer back to this site at bcbsga.com/hca or call the Member Services number on your Blue Cross and Blue Shield of Georgia, Inc. or Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. (collectively “BCBSGa”) ID card.
Q: Why will HCA no longer participate in the BCBSGa network?
The current contract between HCA and BCBSGa expired on September 30, 2018. We are working hard to reach a mutually beneficial agreement with HCA, including rates that are reasonable, fair and competitive, as well as contract terms that protect our members. Unfortunately, we were unable to reach an agreement before October 1, 2018. HCA is no longer in-network as of October 1, 2018.
Q: Which facilities are affected by this?
The following Georgia facilities are affected: Atlanta Outpatient Surgery Center, Augusta Surgical Center, Cartersville Medical Center, Coliseum Medical Center, Coliseum Same Day Surgery, Doctors Hospital of Augusta, Eastside Medical Center, Evans Surgery Center, Fairview Park Medical Center, Marietta Surgical Center, Memorial Health University Medical Center, Memorial Satilla Health, Northlake Surgical Center, Redmond Regional Medical Center and Surgery Center of Rome.
Q: What provider groups are affected by this?
The following Georgia provider groups are affected: Augusta Primary Care Services, Augusta Specialty Hospitalists, Coliseum Primary Care Services, Dublin Multispecialty, Eastside Behavioral Health Associates, Eastside General Surgery, Eastside Heart and Vascular, Eastside Urgent Care, Grayson Primary Care, Greater Gwinnett Internal Medicine Assoc., Intensive Care Consortium, Macon Psychiatric Hospitalists, Memorial Family Practice Associates, Memorial Satilla Specialists, Neurosurgery Atlanta, North Georgia Primary Care Group, Redmond Physician Practice Company, Savannah Multispecialty Associates, Savannah Pediatric Care and Savannah Primary Care Associates.
Q: What BCBSGa products/programs will be affected?
- Par/Trad (indemnity)
- Open Access
- Pathway X
- Pathway Enhanced
- Pathway X Enhanced
- Pathway X Guided Access
- Advantage PPO
- Advantage HMO
Q: I have a Blue Value Secure (Medicare Advantage HMO) plan. How will this affect my MA HMO benefits?
Blue Value Secure members are advised to call a dedicated Medicare customer service number with any questions at 1-866-438-9968. TDD/TTY members can call 1-877-247-1657. Both of these lines are open from 8:00 a.m. to 8:00 p.m., 7 days a week.
Q: Does this termination affect doctors?
Yes. Doctors who only admit to HCA, and do not have admitting privileges to another participating hospital in your plan, are no longer in your plan as of October 1, 2018. That means if you continue to see them, you’ll pay more out-of-pocket costs.
Q: I want to avoid higher costs. What if my doctor typically admits his/her patients to HCA and doesn’t have admitting privileges to other hospitals in my plan?
You should talk to your doctor about other options. Many doctors have admitting privileges at more than one area hospital. Doctors who admit only to HCA and do not have admitting privileges to another hospital in your plan, are no longer in your plan as of October 1, 2018. This means it will cost more to see them.
Q: What are the alternative in-network 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. Find a Doctor has a complete list of providers or call the customer service number on the back of your BCBSGa ID card.
Q: What happens if I go to HCA on or after October 1, 2018?
In order to get the most out of your benefits, we recommend you consider changing to a doctor or provider in your plan. If you go to HCA on or after October 1, 2018, you’ll pay more out of pocket and the hospital may charge you for the difference between what they charge and what we reimburse.
If you are a POS 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. Additionally, the provider may bill you for the difference between our reimbursement and their billed 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 non-emergency services you receive. In order to receive the highest level of benefits for any procedures that you may have scheduled at HCA on or after October 1, 2018, it will be necessary for your physician to refer you to an in-network provider who can provide care at a hospital or facility that participates with BCBSGa. This will ensure that those services are covered at the highest possible level of benefit.
In emergency situations, go to the nearest facility.
Q: What if I’m in the middle of treatment with an HCA doctor?
If you’re seeing an HCA doctor who doesn’t have admitting privileges to another hospital in your plan, you may be eligible for continuity of care benefits. This means you may be able to continue to see them with the same benefits you’d have for a doctor in your plan for a limited time on or after October 1, 2018. To be eligible, you must be in active treatment for a specific medical condition. Please call the customer service number on the back of your ID card for more details.
Q: Will I be covered for emergency care services at HCA?
Yes. Emergency services at any appropriate facility or hospital, including HCA, will continue to be covered in accordance with your benefit plan and governing state and federal laws. You may be responsible for charges over your plan allowance in accordance with the terms of your benefit plan.Still have questions?
Please call us at the Member Services number listed on your member ID card.