1.Question
/ Why can’t Blue Cross Blue Shield of Georgia (BCBSGa) reach agreement with the Medical Center of Central Georgia (MCCG)?Answer
/ We believe the Medical Center of Central Georgia’s (MCCG) financial requirements are extraordinary and inconsistent with maintaining the affordability of health care coverage. Our members and MCCG’s patients are best served by a long term, mutually beneficial relationship, but at this time, we have a fundamental disagreement over appropriate reimbursements for services delivered. In addition, MCCG wanted an exclusive arrangement for both our HMO and PPO networks and we believe that our members deserve choice.2.Question
/ When will the Medical Center of Central Georgia be back in the network?Answer
/ Regrettably, it is impossible to know whether, or if, MCCG will rejoin our network. We remain open to the negotiation process should MCCG reconsider its position and decide to join us in keeping health care affordable and accessible.3.Question
/ Why not agree to MCCG’s terms to make it easier for people to get the health care they need?Answer
/ Our members expect us to do all within our power to make health care insurance affordable and accessible. Agreeing to MCCG’s requirements would undermine our commitment to our members. We continue to have contracts with facilities and physicians in the Macon network to ensure access for our members.4.Question
/What is the effective date of the termination from Blue Cross Blue Shield of Georgia/Blue Cross Blue Shield Healthcare Plan of Georgia HMO/POS, PPO and Indemnity networks?
Answer
/October 1, 2005
- Question
Has BCBSGa contracted with any additional hospitals in the Macon area?
Answer
/Yes. We are pleased to welcome Coliseum Medical Center and Macon Northside Hospital to our HMO/POS and PPO networks effective October 1, 2005.
- Question
How do I find another network hospital?
Answer
/ Included with this Member Q&A is a listing of network hospitals in the Macon area.- Question
What should I do in case of an emergency?
Answer
/ Call 911 immediately or go to the nearest hospital emergency room. You should not worry if the hospital closest to you is in-network or out-of-network if you feel that you have a life or limb-threatening emergency. You, or someone else, should call your physician the next business day to inform him/her of the visit and arrange follow-up care.- Question
Will BCBSGa cover services that are only available at Medical Center of Central Georgia?
Answer
/Any medical services that are only available at MCCG will be considered in-network for HMO/POS, PPO and Indemnity members.
- Question
Does this change my benefits in any way?
Answer
/ No. Your benefits remain unchanged. If you have a question about your benefits, please refer to your Certificate Booklet or call customer care at the number listed on your member ID card.- Question
Does this change increase my premiums?
Answer
/No. You will not pay any additional money for your current health insurance coverage.
- Question
I am an HMO/POS member; will I have to change my PCP?
Answer / If your PCP only has admitting privileges at MCCG and does not have privileges at another BCBSGa network hospital or he/she chooses to not pursue privileges at another BCBSGa network hospital, then you will need to choose another PCP.A list of MCCG affiliated physicians who have terminated their contracts with BCBSGa/BCBSHP is included with this packet of information. If your PCP appears on the list, please contact our customer care associates to change your PCP to a network physician.
Both Coliseum Medical Center and Macon Northside Hospital are open to admitting new physicians so you can talk to your physician about obtaining privileges at those hospitals.
- Question
I am an HMO/POS member; how can I change my primary care physician (PCP)?
Answer / You have two options:- Call the customer care number on your member ID card. Our customer care associates will be happy to assist you.
- If you already have a username and password for Member Access, our online member transaction service, simply go to and type your information in the fields provided on the left-hand side of the screen. Select “Change PCP” from the menu of options and follow the steps on the screen.
- Question
What if I go to MCCG anyway?
Answer
/ HMO Members: Your plan does not provide coverage if you receive services from an out-of-network provider. If you receive services from MCCG after October 1, you will be responsible for the full cost of the services. (Note: If you are pregnant or suffer from a chronic condition, please refer to Questions 16 and 17. If you are obtaining coverage for services only available at MCCG, please refer to Question 8.)POS, PPO and Indemnity Members: You have the choice of using in- or out-of-network providers for your care. However, you will receive greater benefit (less cost) if you use a network provider and you will not be subject to balance billing. See your Certificate Booklet for details.
- Question
I have a service scheduled at MCCG after September 30; what do I do?
Answer
/If you have a service scheduled after September 30 at MCCG, our utilization management department will work with you and your physician to ensure that your services are provided at an in-network facility. To access our utilization management department, please call the pre-certification number listed on the back of your member ID card.
- Question
I am pregnant. Do I have to change OB/GYNs if my doctor only has privileges at MCCG?
Answer / If you are less than 28 weeks pregnant as of September 30, 2005:HMO members:If you are an HMO member, your OB/GYN does not have privileges at an HMO network hospital, and you are less than 28 weeks pregnant as of September 30, 2005, then you will need to select another HMO OB/GYN who has privileges at an HMO network hospital. If there are medical reasons to continue your care under your current OB/GYN, please ask your OB/GYN to contact the pre-certification number on the back of your member ID card.
POS members: If you are a POS member, your OB/GYN does not have privileges at a POS network hospital, and you are less than 28 weeks pregnant as of September 30, 2005, then you will need to select another HMO OB/GYN who has privileges at a POS network hospital to receive in-network benefits. If you choose to deliver at MCCG, then you will receive out-of-network benefits and may be subject to balance billing. If there are medical reasons to continue your care under your current OB/GYN, please ask your OB/GYN to contact the pre-certification number on the back of your member ID card.
PPO members: If you are a PPO member, your OB/GYN does not have privileges at a PPO network hospital, and you are less than 28 weeks pregnant as of September 30, 2005, then you will need to select another PPO OB/GYN who has privileges at a PPO network hospital to receive in-network benefits and avoid balance billing. If you choose to deliver at MCCG, then you will receive out-of-network benefits and may be subject to balance billing. If there are medical reasons to continue your care under your current OB/GYN, please have your OB/GYN to contact the pre-certification number on the back of your member ID card.
Indemnity members: If you are an indemnity member and your OB/GYN does not have privileges at a PAR network hospital, then you will need to select another PAR OB/GYN who has privileges at a PAR network hospital to avoid balance billing.
In all cases, you can talk to your physician about obtaining privileges at another network hospital. Coliseum Health System is open to accepting new physicians.
If you are 28 weeks or more pregnant as of September 30, 2005:
HMO members: If your current participating OB/GYN has privileges at an HMO network hospital, you may deliver at an HMO network hospital or MCCG. If your current OB/GYN no longer has privileges at an HMO network hospital and you are 28 weeks or more pregnant as of September 30, 2005, you will not have to change OB/GYNs and may also deliver at MCCG.
POS members: If your current participating OB/GYN has privileges at a POS network hospital, you may deliver at a POS network hospital or MCCG. If your current OB/GYN no longer has privileges at a POS network hospital and you are 28 weeks or more pregnant as of September 30, 2005, you will not have to change OB/GYNs and may also deliver at MCCG.
PPO members: If your current participating OB/GYN has privileges at a PPO network hospital, you may deliver at a PPO network hospital or MCCG. If your current OB/GYN no longer has privileges at a PPO network hospital and you are 28 weeks or more pregnant as of September 30, 2005, you will not have to change OB/GYNs and may also deliver at MCCG.
Indemnity members: If your current participating OB/GYN has privileges at a PAR network hospital, you may deliver at a PAR network hospital or MCCG. If your current OB/GYN no longer has privileges at a PAR network hospital and you are 28 weeks or more pregnant as of September 30, 2005, you will not have to change OB/GYNs and may also deliver at MCCG.
Any claims for deliveries at MCCG for members who are 28 weeks or more pregnant as of September 30, 2005 will be reimbursed at the in-network benefit level.
- Question
Answer
/Our customer care associates stand ready to assist you with your chronic condition and continuity of care needs. Our utilization management team will work with you regarding your physician’s individual network status. To access our utilization management department, please call the pre-certification number listed on the back of your member ID card.
17. Question
/Who do I call if I have questions?
Answer
/Please call the customer care number listed on your member ID card. Our representatives are available to assist you Monday through Friday from 7:00 AM to 7:00 PM.
Independent Licensee of the Blue Cross Blue Shield Association