Apr 3, 2018 | Atlanta, GA
As of April 1, Piedmont Healthcare doctors and hospitals became out-of-network providers for employees enrolled in a Blue Cross Blue Shield of Georgia (BCBSGa) health care plan.
Georgia Tech Human Resources will continue to monitor the negotiations and communicate as additional information becomes available. For now, read on for what you need to know if you or your family members are enrolled in a BCBSGa plan.
Since negotiations have thus far been unsuccessful, continuing to use Piedmont doctors and facilities will be considered out-of-network unless you are approved through a Continuation of Care request. Employees or their dependents who are subscribed to a BCBSGa plan and already being treated for a specific medical condition may apply to receive in-network-level benefits for a limited time. Here is a form with additional information about Continuation of Care and how to apply. Without Continuation of Care, out-of-network rates will apply.
For Consumer Choice HSA and Comprehensive Care Members
Out-of-network care will be covered at 60 percent of the negotiated rate, subject to any deductibles. In this case, you will be subject to balance billing. Balance billing is the process where the provider bills the patient for the remaining portion of the full charge that BCBSGa did not pay.
Example: Out-of-network Piedmont ER visit
Full Rate = $1,200*
BCBSGa negotiated rate = $500*
- BCBSGa will pay 60 percent of the BCBSGa negotiated rate, or $300
- Piedmont will then balance bill the patient $900 as the remaining amount of the Full Rate
*Not actual amounts; used for example purposes only. These amounts could be higher or lower than shown.
For BlueChoice HMO Members
Out-of-network care is not covered under the BCBSGa HMO plan. Employees enrolled in the BCBSGa HMO plan would be responsible for the full cost of care.
To determine if any of your physicians or providers are affiliated with Piedmont Healthcare, use the Piedmont Healthcare Physician search tool. To avoid incurring the higher costs of using an out-of-network doctor, use the “Find a Doctor” tool on the BCBSGa microsite to find in-network physicians. You will be able to find a listing of in-network BCBSGa doctors and facilities in your area by sorting the type of doctor or specialty. You also will want to confirm that the doctor you choose is not represented in the Piedmont Healthcare Physician search tool.