Northeast Georgia Health System (NGHS) and Anthem/Blue Cross Blue Shield (BCBS) of Georgia’s contract lapsed September 30, 2019. Those negotiations involved coverage for services provided to Anthem/BCBS commercial health insurance plan members at most NGHS facilities.
Longstreet Clinic is a physician-owned multi-specialty practice that operates independently from NGHS, therefore we have a separate contract with Anthem/BCBS. Our contract with Anthem/BCBS remains in place and is not impacted by the decision by Anthem and NGHS to allow their contract to expire. All Longstreet Clinic physicians and locations remain in network for Anthem/BCBS members.
Although we hoped our friends at NGHS and Anthem would reach an agreement before the deadline, we have been preparing for this possibility in hopes of minimizing any impact for our patients who may need care at an NGHS facility.
Frequently Asked Questions
I’m an Anthem member and a patient at Longstreet Clinic. How does the NGHS/Anthem contract expiration affect me and my family?
As far as the care you receive from Longstreet Clinic providers in our offices, you can expect to receive the same level of care and coverage as usual. Longstreet Clinic negotiates its own separate contracts with insurance providers, which means our services will remain available at the same in-network rates to which you are accustomed.
However, should you require hospital care from one of our providers, charges from the Northeast Georgia Medical Center facility where you receive care could be considered out of network, which may mean higher rates for members. This contract change does not affect any Anthem Medicare supplement, Medicare Advantage (Replacement) or Medicare State Health Benefit Plans.
Gainesville Surgery Center and Gwinnett Medical Center facilities are not affected by this negotiation and remain in network for Anthem/BCBS members. Procedures scheduled at these facilities are not impacted.
I’m pregnant and receive obstetrical care at Longstreet Clinic, but I’m due to deliver at NGMC soon OR I see a Longstreet Clinic surgeon and am planning to have surgery at NGMC OR My dad is an oncology patient at Longstreet who receives some treatment at NGMC. What should I do?
Longstreet Clinic patients who may need treatment at a NGHS facility who are in active care and completing a course of treatment with a Longstreet Clinic provider should have continuous in-network coverage under Continuity of Care requirements. For those patients in active treatment or with known procedures, inpatient or outpatient, at NGMC (e.g., obstetrics, oncology, hematology, surgery, etc), it will be necessary for Longstreet Clinic staff to work with you to complete the necessary paperwork needed to claim continuity of care. Longstreet Clinic staff will follow guidance from Anthem to assure your services are considered in network.
If I am an Anthem policy holder, what comes next?
We continue to monitor the situation and remain in regular contact with Anthem leadership and NGMC leadership. While it is our hope that both parties will reach an agreement soon, Longstreet Clinic will continue providing expert medical care to our patients across the region. While we understand this process can be confusing and stressful, we hope this information has provided some answers to questions you may have about these negotiations. Please don’t hesitate to contact your provider’s office should you have additional questions.
If you have any questions please feel free to call 770-533-4760. We have set up this number specifically to help us hear from you and work with you to answer questions. The number is staffed by a LC patient service representative who will have resources to help navigate the situation. If you have to leave a voicemail, we commit to you to return your call promptly.
Northeast Georgia Health System and Anthem/BCBS have published web pages with information and resources you can find here:
- NGHS: www.nghs.com/anthem
- Anthem: www.anthem.com/nghs