Posted: 7:32 p.m. Sunday, April 01, 2018
Saturday night’s stalemate between Blue Cross Blue Shield of Georgia and Piedmont Healthcare over a new contract will force at least half a million Georgia Piedmont patients to pay out-of-network costs for their current doctors.
Negotiations will continue, said Matt Gove, Piedmont Healthcare’s chief consumer officer.
The two companies, Georgia’s largest health insurer and one of the state’s largest health care provider groups, have been in tense negotiations for weeks over their contract renewal. The previous contract ended Saturday night. The menu of issues at stake included how much Blue Cross would reimburse Piedmont and its doctors for services, and terms such as what services it would cover.
The companies have not detailed the key sticking points, but they have been in court over Blue Cross’ reluctance to fund some in-hospital MRIs and CAT scans when they can be done for less elsewhere, and to fund emergency-room care when Blue Cross decides it was not warranted. A Piedmont spokesman also said doctor payments were a roadblock.
For patients with imminent need for care, the failure now means uncertainty. In a few circumstances of ongoing care, network prices will be grandfathered in. But for most, they must either find a new care provider or risk being stuck with much higher out-of-network costs such as copays if they go to their familiar caregiver.