5 things to know about Blue Cross and Piedmont Hospital dispute

Two of Georgia’s biggest names in health care are at odds as the clock ticks down on their contract.

Blue Cross Blue Shield of Georgia, under its parent company, Anthem Inc., is in contract negotiations with Piedmont Hospital. If they don’t come to agreement by March 31, Piedmont patients with Blue Cross company plans will suddenly be out of network, meaning higher costs. Yes, according to Blue Cross that includes members of Georgia’s State Health Benefits Plan and the Federal Employees Plan. Here’s what it means:

Is this for all Piedmont patients with Blue Cross?

No. According to Piedmont, customers under Medicare Advantage plans are not affected in this go-round — unless they go to Piedmont Newton Hospital. So the Piedmont Newton Hospital patients with Blue Cross got included in this contract. In contrast, Piedmont Rockdale Hospital and Piedmont Columbus Regional are not affected by the outcome of these specific contract talks.

Does it affect clinics, too?

Looks like. All Piedmont Clinic doctors will also be out of network if this contract

isn’t renewed.

Is the contract doomed?

No. Nothing changes this month. And if they reach agreement by March 31, nothing changes then, either. Blue Cross customers have gotten worrisome letters, but those are seen as a requirement to give notice. Hospitals allege such letters are a negotiating tactic, though insurers would disagree. In any case, according to the

state Department of Insurance, Blue Cross and Piedmont have been down this road before, issuing such letters perhaps half a dozen times in the past two decades.

Is it smooth sailing?

No. It’s never smooth sailing, but it may be worse this time around. Blue Cross has instituted two nationally controversial reimbursement restrictions, refusing to cover some emergency room visits and hospital MRIs and

CAT scans. Piedmont has sued. If they’re already in court, there’s some stiff disagreement.

Where can I get answers?

Blue Cross suggests customers go to bcbsga.com/ piedmont.

And Piedmont Hospital suggests patients go to this website: keeppiedmont.org.

Blue Cross also says its customer service line (on insurance ID cards) is available.

ARIEL HART / AHART@AJC.COM Anthem Inc. is the parent company of Blue Cross Blue Shield of Georgia. Shown here, the Feb. 21 groundbreaking for a new Midtown Atlanta office tower for the Indianapolisbased company’s technology services.