Northeast Georgia Health System (NGHS): Update on Your Health Plan’s NetworkOctober 10, 2019
Effective October 1, 2019, Northeast Georgia Health System (NGHS) is no longer available as an in-network care provider with Anthem Blue Cross and Blue Shield (Anthem).
This means NGHS services received on or after October 1, 2019 will be considered out-of-network and may be reimbursed as out-of-network under the terms of your health plan with some exceptions noted below in the Common FAQs section.
We're committed to reaching an agreement that continues to give you access to affordable care – and also makes sure that NGHS is compensated fairly. Our members are our top priority, so we’re hoping to sign a contract soon so you can regain access to in-network care from NGHS.
Read over some common questions and answers below. If you have other questions or need help finding a doctor or hospital, you can call the Member Services number on your Anthem ID card. For a complete list of providers, log on to anthem.com and select Find a Doctor.
- Healthlink Laboratory – Braselton Medical Plaza I
- Healthlink Laboratory – Dawsonville Medical Plaza 400
- Healthlink Laboratory – Gainesville
- Hospice of Northeast Georgia Medical Center
- Laurelwood (Psych)
- New Horizons Lanier Park
- New Horizons Limestone
- Northeast Georgia Medical Center Barrow
- Northeast Georgia Medical Center Braselton
- Northeast Georgia Medical Center Gainesville
- Sleep Disorder Center of NGMC – Braselton
- Sleep Disorder Center of NGMC – Gainesville
- The Imaging Center – Barrow
- The Imaging Center – Braselton Medical Plaza I
- The Imaging Center – Buford
- The Imagine Center – Dawsonville Medical Plaza 400
- The Imaging Center – Gainesville Medical Park I
- The Rehabilitation Institute
- The Rehabilitation Institute – Braselton Medical Plaza I
- The Rehabilitation Institute – Buford
- The Rehabilitation Institute – Cleveland
- The Rehabilitation Institute – Dahlonega
- The Rehabilitation Institute – Dawsonville
- The Rehabilitation Institute at Sherwood Park - Gainesville
- The Ronnie Green Heart Center
- The Toccoa Cancer Center
- Northeast Georgia Physicians Group
- The Heart Center, LLC
- Urgent Care
A: All of the Anthem networks that are currently contracted with NGHS are affected. This includes the network for the State Health Benefit Plan.
- POS and PPO: NGHS is no longer in our network as of October 1, 2019, so consumers will need to use an in-network care provider for non-emergencies to receive in-network benefits under your plan. Those who choose to see an out-of-network care provider will be subject to higher costs. Additionally, the care provider can bill consumers if there is a difference between what Anthem allows or pays for the claim and the amount the provider charges the consumer.
- HMO: NGHS is no longer in our network as of October 1, 2019, so consumers will need to use an in-network care provider for non-emergencies to receive in-network benefits or coverage under your plan. Those who choose to see an out-of-network care provider will be subject to higher costs, including the full cost of care.
A: Members wishing to request continuity of care should contact their new participating medical group or PCP. If an Anthem member began a course of treatment with NGHS before the Sept. 30, 2019 termination for one of the following conditions, he or she may be eligible to receive continuity of care:
- The member is in an active course of treatment for an acute medical condition, behavioral health condition, or serious chronic condition.
- The member is pregnant, regardless of trimester.
- The member has a terminal illness.
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 Anthem ID card to get a copy mailed or emailed to you.
- Please answer all questions completely. To help us review your form quickly, 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 health care provider or doctor.
- The treating health care provider should fax the completed form to Medical Management at 1-877-254-4971.
We’ll review it and let you know if you can continue your health 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 health care providers to get in-network benefits, we’ll help you find a hospital or facility that fits your needs.
A: A hospital’s emergency medical services are considered a covered benefit and therefore do not require pre-authorization, regardless of where they are delivered. The NGHS hospitals must provide services for members requiring emergency care. Coverage will be provided according to the member’s policy benefits. Anthem encourages members to make informed decisions about when to use urgent care as opposed to emergency room care. Urgent care is appropriate when a member needs a physician’s attention for a condition that is non-life threatening. A member who needs urgent care should go to the nearest immediate or urgent care facility when his or her physician or network provider is unavailable.
A: Only members participating in a Gatekeeper HMO plan with an NGHS Primary Care Physician will be reassigned to a new in-network PCP and receive a new member ID card reflecting this change. If you believe you should have received a new ID card and have not, please visit the online member portal at Anthem.com to print your ID card, or contact the Member Services number on your existing Anthem ID card. Updated ID cards are also available on our mobile app.