Skip to Content

  • What is happening between Piedmont Healthcare and Anthem Blue Cross Blue Shield of Georgia (Anthem/Blue Cross)?

    Piedmont Healthcare has been in discussions with Anthem Blue Cross on a new contract to cover the physician and hospital services Piedmont provide to Anthem Blue Cross commercial members – employer-sponsored and non-employer sponsored individual/family health plans.

    The contract between Piedmont Healthcare and Anthem Blue Cross expired March 31, 2018. While we began discussions with Anthem Blue Cross in September 2017, we were not able to reach an agreeable resolution before the expiration date.

    Patients can continue to see their Piedmont physicians, but in most cases will have a higher out-of-pocket costs. We know this is difficult for our patients, and we will do whatever we can to help our patients manage the impact of this disruption.

    We can help our patients understand how much the out-of-pocket costs might be. Patients who have scheduled or are considering a hospital service (surgery, imaging study, etc.) can call Piedmont’s Customer Solutions Center at 1-855-788-1212. Patients with an upcoming physician office appointment or who need to see their physician can call his or her office.

  • Which Piedmont facilities and Anthem Blue Cross health plans are affected by the negotiations?

    Beginning April 1, 2018, most Piedmont Healthcare facilities and Piedmont Clinic physicians are not a part of the Anthem Blue Cross network. Below are the hospitals and plans that are impacted.

    Piedmont Atlanta Hospital
    (including Piedmont West Ambulatory Service Center)
    All Anthem Blue Cross Blue Shield commercial plans
    Piedmont Athens Regional All Anthem Blue Cross Blue Shield commercial plans
    Piedmont Fayette Hospital All Anthem Blue Cross Blue Shield commercial plans
    Piedmont Henry Hospital All Anthem Blue Cross Blue Shield commercial plans
    Piedmont Mountainside Hospital All Anthem Blue Cross Blue Shield commercial plans
    Piedmont Newnan Hospital All Anthem Blue Cross Blue Shield commercial plans
    Piedmont Newton Hospital All Anthem Blue Cross Blue Shield commercial plans
    Anthem Blue Cross Medicare Advantage plans
    Piedmont Clinic Physicians* All Anthem Blue Cross Blue Shield commercial plans

     

    All Anthem Blue Cross Blue Shield commercial health plans as well as the Medicare Advantage plan for Piedmont Newton Hospital are impacted. These negotiations do not have an effect on any other Medicare, Medicare Advantage, or Managed Medicaid plans – only the one at Piedmont Newton. 

    If you are a Blue Cross Blue Shield member and are unsure if your plan is included, call the number on your medical benefits card.

    Piedmont Rockdale and Piedmont Columbus Regional facilities’ contracts did not expire on March 31, 2018. That means these locations will continue to be an in-network provider.

    *To see if your Piedmont Clinic physician is impacted by the negotiation – meaning, they are not in the Anthem Blue Cross beginning April 1– search our provider directory.

  • Are there any exclusions to Piedmont’s Out of Network status with Anthem Blue Cross?

    There are two specific exclusions to the April 1, 2018 out of network status.

    Emergency Room Visits: Patients will always have in-network access to our emergency room, regardless of our contract status and can expect to be covered at in-network benefit levels according to state and federal law. If a patient experiences an emergency, they should immediately visit the nearest emergency room.

    Blue Cross Blue Shield Federal Employee Program (FEP) members: As we understand from a recent FEP mailing to their members, FEP members (both Standard and Basic Plan members) will have in-network benefit levels paid through May 30, 2018. Insurers are required to give FEP members 90 days’ notice, and they were first notified on March 1, 2018.

    According to the Blue Cross Blue Shield letter, FEP members who are pregnant or are currently receiving care for certain conditions may be eligible to request continuity of care services from Piedmont. Call 800-282-2473 to submit a request.

    Self-insured employers: Some self-funded employers have elected to extend in-network benefits for their employees. Piedmont has been able to confirm that these include:

    • State Health Employee Plan
    • Board of Regents
    • Home Depot
    • Southern Company Georgia Power
  • How can I find out what a hospital procedure or physician’s office visit might cost me?

    Patients who have scheduled or are considering a hospital service (surgery, imaging study, etc.) can call Piedmont’s Customer Solutions Center at 1-855-788-1212. Patients with an upcoming physician office appointment or who need to see their physician can call his or her office.

  • I work in Georgia, but my medical benefits aren’t through Blue Cross Blue Shield of Georgia - my member benefits are headquartered in another state. Am I impacted?

    Blue Cross Blue Shield plans are part of a national association, and access to the Blue Cross network is consistent through the association, regardless of which state the plan originates in. If you are an employee who lives and works in Georgia but your company’s headquarters are in another state and provides your medical benefits through that state’s Blue Cross Blue Shield plan, your Piedmont physicians and hospitals (listed above) are out-of-network.

  • I have Anthem/Blue Cross commercial employer sponsored health plan or an individual/family health plan. What does this mean for me?

    Because Piedmont and Anthem Blue Cross was unable to reach an agreement by March 31, 2018, Piedmont facilities (with the exception of Piedmont Rockdale and Piedmont Columbus Regional) and Piedmont Clinic physicians are out-of-network providers for all Anthem Blue Cross members beginning April 1, 2018.

    This means that Anthem Blue Cross members may have to pay higher out-of-pocket costs to continue care with our providers.

    Some patients may qualify for Continuity of Care benefits, which would extend their in-network access to Piedmont facilities and physicians after April 1. Patients currently in a course of treatment are encouraged to call the customer service number on the back of their insurance card to see if they qualify for Continuity of Care benefits. Pregnant patients (any trimester) are eligible for continued coverage through Continuity of Care, which includes mother, baby and hospitalization, as long as they were pregnant and under the care of a Piedmont physician before the contract termination date, April 1, 2018.

    For additional information and to confirm eligibility, patients should download the Anthem Blue Cross Continuity of Care form and follow the instructions listed on the form to begin the process or call the Anthem Blue Cross member services phone number on the back of their insurance ID card. We will help our patients in every way possible to ensure they can continue their in-network access with the doctors and at the facilities they know and trust.

    If you are a Blue Cross Blue Shield member from another state and need to apply for Continuity of Care, your form may be different. Contact the Blue Cross Blue Shield number on the back of your member benefits card and request a Continuity of Care form.

  • What if I have a doctor’s appointment or elective procedure scheduled at Piedmont after April 1, 2018?

    We understand that some patients already have appointments scheduled on or after April 1, 2018. If this is the case, you may call your doctor’s office to reschedule this appointment for a delayed date, or you may keep your appointment and be subject to potentially paying higher out-of-pocket costs.

    We encourage you to call the customer service phone number on the back of your insurance card to understand your rights for Continuity of Care benefits, which may temporarily extend your ability to receive in-network care for certain conditions at Piedmont.

  • What is the current status of discussions and what are the negotiations about?

    Piedmont and Anthem Blue Cross are continuing to meet frequently in order to come to a resolution for a renewed contract. While out of network status are not common, contract discussions between healthcare providers and insurance companies are normal.

    Fair contracts with health insurers are vital to the long-term financial sustainability of healthcare providers, like Piedmont. In order to adequately invest in our communities and provide the high-quality care that you and your family deserve and rely on, we depend on fair contracts that allow us to keep up with inflation and increasing prescription drug costs.

    It is also important for our physicians to be compensated fairly. Patients rely on their doctor, and we rely on them, too. Piedmont was founded by two physicians, so physicians are at the core of who we are. We will not agree to anything with Anthem Blue Cross that does not fairly compensate and recognize how integral physicians are to our mission.

    We’ve made a commitment to preserve and improve access to quality healthcare across communities in North Georgia, but we need fair and reasonable contracts with health insurers to do so.

  • What other commercial insurance companies are in network with Piedmont facilities and Piedmont Clinic physicians?

    Piedmont is in network with the following commercial insurance companies for the entire 2018 year:

    • Aetna
    • Cigna
    • Humana
    • Kaiser Permanente (except Piedmont QuickCare locations)
    • United Healthcare
    • Alliant
    • MultiPlan
    • NovaNet
    • Coventry
    • Beech Street
  • How can I stay up-to-date on the negotiations?

    As our discussions with Anthem/Blue Cross progress, we will keep you updated of any changes that may affect your access to Piedmont providers. For the most immediate updates, please contact us.

Piedmont Healthcare