ATLANTA, July 1 /PRNewswire/ -- Blue Cross Blue Shield of Georgia (BCBSGa) announced today that its contracts with Piedmont Healthcare expired at midnight on Friday, June 30, 2006. This contract expiration will impact BCBSGa HMO/POS and PPO members who have accessed Piedmont Healthcare as an in-network provider.
For nearly six months, BCBSGa has negotiated in good faith with Piedmont Healthcare in an effort to reach an agreement that would allow Piedmont to continue caring for BCBSGa members, and still profit from the contracts.
"Piedmont Healthcare repeatedly rejected BCBSGa's offers of significant increases and, instead, inexplicably insisted on rate increases that were much higher than comparable hospitals," said Caz Matthews, BCBSGa president. "Regrettably, Piedmont Healthcare continued to insist on reimbursement rates that were significantly out-of-line with the metro-Atlanta market and if we had agreed to their demands, the cost of health care would have increased beyond a rate acceptable to our members and employer groups.
"Ultimately, it would be irresponsible to members for BCBSGa to keep Piedmont Healthcare in our network at the reimbursement rates they were requesting," said Matthews.
In the past three weeks, Piedmont Healthcare has filed two separate lawsuits against BCBSGa.
"The lawsuits brought against BCBSGa by Piedmont Healthcare have been an attempt to deflect attention away from the real impediment to reaching an agreement -- Piedmont Healthcare's demands for excessive reimbursement rates," said Matthews. "Unfortunately, these lawsuits have only served to prevent the two parties from focusing on negotiating an agreement."
Piedmont Mountainside Hospital's contracts have not expired and will remain in the BCBSGa HMO/POS and PPO networks. In addition, BCBSGa's contracts with Newnan Hospital, which may be purchased in the future by Piedmont Healthcare, are currently not affected.
PPO and POS members may continue to seek services from Piedmont Healthcare facilities and physicians, but services will be considered out-of-network and subject to higher coinsurance paid out of members' pockets directly to the affected facilities and physicians of Piedmont Healthcare. For HMO members, services at an impacted Piedmont facility or physician will be considered out-of-network. HMO members who receive non-emergency services will be responsible for the full cost of these services.
In accordance with Georgia law, BCBSGa members who are eligible for continuity of care can continue to receive their care from a Piedmont Healthcare facility or physician, and it will be considered in-network for a period of time.
Members who are pregnant and receiving care in connection with their pregnancy on or before June 30 still have in-network benefits for services of a Piedmont physician and a Piedmont hospital throughout the remainder of the pregnancy, including six weeks post-delivery care.
BCBSGa members who have Medicare Supplemental insurance will not be affected by the contract expirations, and all Piedmont Healthcare facilities will be considered in-network.
"I have been astonished by Piedmont Healthcare's inflexible and relentless demands for reimbursement rates that bear no correlation to the prevailing marketplace rates," said Matthews. "There are currently 36 hospitals in the metro-Atlanta area participating in the BCBSGa network, and the metro-Atlanta area is fortunate to have so many quality hospitals in close vicinity that offer the same services as Piedmont Healthcare," said Matthews.
"We remained open to continued dialogue until midnight with Piedmont Healthcare, but they have yet to acknowledge BCBSGa's final offer made on June 20," said Matthews. "Our members remain our first priority and we are truly committed to providing them with access to affordable, quality health care. Ultimately, affordability is key to accessibility."
The following information provides information on continuity of care for BCBSGa members:
* Members receiving active health care services for a chronic or terminal
illness still have in-network benefits for services from their Piedmont
physician for up to 60 days after the physician's contract ends.
* Members receiving care as in-patients at Piedmont Hospital or Piedmont
Fayette Hospital on June 30, 2006, still have in-network benefits for
services from their Piedmont physicians for up to 60 days.
* Members who are pregnant and receiving care in connection with their
pregnancy on or before June 30 still have in-network benefits for
services of their Piedmont physician and their Piedmont hospital
throughout the remainder of the pregnancy, including six weeks
post-delivery care.
* Members receiving care as in-patients at Piedmont Hospital or at
Piedmont Fayette Hospital on June 30, 2006, still have in-network
benefits for hospital services until their discharge or transfer or for
up to 60 days.
* Members in need of emergency medical services still have in-network
coverage for such services at the emergency departments of Piedmont
Hospital or Piedmont Fayette Hospital.
* The continuation of care benefits described above will be available for
up to 90 days for members with HMO or POS plans.
* Members who are eligible for benefits through a Federal Employees Health
Benefit Plan (FEHBP) are eligible for up to 90 days continuation of care
for all physician, hospital, and other provider services.
* Members in self-funded plans whose coverage is administered by BCBSGa
will have the continuation of care benefits described above unless their
employer directs BCBSGa otherwise. Members will be notified if they are
in a self funded plan and their employer has directed us to administer
more restrictive continuing coverage benefits.
* For members of a Blue Cross and/or Blue Shield plan whose coverage is
issued by a Blue Cross and/or Blue Shield plan other than BCBSGa, they
are encouraged to contact the customer service number on their
identification card to verify continuing coverage benefits.
* All members with BCBSGa PPO or POS insurance coverage still have
out-of-network benefits for services from Piedmont hospitals and
Piedmont physicians as long as their policies remain in effect.
* Members who have BCBSGa Medicare Supplemental coverage and members who
seek hospital services at Piedmont Mountainside Hospital are not
affected by the expiration of the Piedmont contracts and still have full
coverage.
About Blue Cross Blue Shield of Georgia
Blue Cross Blue Shield of Georgia is an independent licensee of the Blue Cross and Blue Shield Association and is an operating subsidiary of WellPoint Inc., the largest publicly traded commercial health benefits company in terms of membership in the United States. WellPoint, Inc. is an independent licensee of the Blue Cross Blue Shield Association and serves its members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as Blue Cross Blue Shield in 10 New York City metropolitan counties and as Blue Cross, Blue Shield or Blue Cross Blue shield in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), Wisconsin; and through UniCare. Additional information about WellPoint is available at http://www.wellpoint.com/ . Blue Cross Blue Shield of Georgia can be found on the web at http://www.bcbsga.com/ .
