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Health & Hospitals

Oct. 2 - The FACTS for Patients at Memorial Health Hospital, as HCA and Blue Cross Blue Shield Failed to Reach Oct. 1 Agreement

Category: Health & Hospitals

By Lou Phelps, Coastal Empire News

October 2, 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,” was the statement Tuesday by BCBS of Georgia, in announcing that they had not completed a new contract with HCA hospital corp, which owns Memorial Health University Medical Center.

Memorial Health is one of only two Level One trauma hospitals in Georgia, and routinely serves patients from a 35-county area. 

Georgia Public Radio ran than the story, as did several area television stations.  But, the coverage was missing an explanation from HCA. 

According to BCBS’s press release to the public and the media, “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,” the health insurer added.

But, according to HCA, “Most hospitals and insurers, like Anthem Blue Cross & Blue Shield of GA, renegotiate their contracts every 3 years. This is a routine practice in the health insurance industry. We always try to make sure new contracts are complete prior to the expiration date of the previous contract. However, sometimes it can take a bit longer. In that case, the contract when signed will typically have an effective date that syncs with the prior contract so that patients are not impacted by these delays. In this case, the new contract will be dated 10/1/2018 to ensure our patients do not experience any gap in their ‘in-network’ coverage.”   Please note that when completing contract paperwork we hold the bills so there is no impact to the patient. We want to make sure that the public understands this,” states HCA.

As BCBS explains, “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.”

The language from both sides of the negotiation appears to indicate that an agreement is eminent.

HCA currently owns eight hospitals in Georgia. 

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