If the contract is terminated Dec. 5, what does it mean to you?
By Matthew Whittle
Published in News on October 27, 2013 1:50 AM
Editor's note: If no agreement is reached by Dec. 4, the contract between Wayne Memorial Hospital and Blue Cross and Blue Shield will be terminated. If that happens, all sides are emphasizing that does not mean that that Blue Cross and Blue Shield customers cannot use Wayne Memorial Hospital. They absolutely still can -- under three conditions.
Emergency care:
The hospital's emergency department is still considered in-network for Blue Cross and Blue Shield customers. That means that for emergency care, nothing changes.
Continuing care:
Customers who receive authorization for in-network services at Wayne Memorial Hospital prior to Dec. 5 will still be considered in-network. Customers who are pregnant or dealing with chronic illnesses also will be allowed to receive in-network care at Wayne Memorial through the Blue Cross Continuity of Care program. Information for customers in both these categories will be sent out in early November. Customers can also receive information by calling the number on the back of their membership cards.
Out-of-network care:
Blue Cross and Blue Shield customers can still use Wayne Memorial for any procedure. But unless it's emergency care or continuing care approval has been granted, it will be considered out-of-network.
This third change is the most important -- both for patients and the hospital.
For patients, it means they must receive prior authorization for any procedure performed at Wayne Memorial. It also means they will pay more out-of-pocket for that procedure.
For the hospital, it means that the overall amount billed to Blue Cross customers will be lower. Furthermore, because the insurance company will then pay its amount directly to the patient, not the hospital, WMH officials expect collections to be "negatively impacted."
In-network care:
To receive in-network care at a hospital, Blue Cross has offered several local alternatives to Wayne Memorial, all within 30 miles: Lenoir Memorial Hospital in Kinston, Wilson Medical Center in Wilson, Johnston Memorial Hospital in Smithfield, Duplin General Hospital (Vidant-Duplin) in Kenansville and Vidant Medical Center in Greenville.
What about other county facilities:
Only Wayne Memorial Hospital is affected directly by this decision. If care at another facility in Wayne County is currently considered in-network it will remain in-network.