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BlueCross BlueShield Network Providers: Are you in? Or, are you out?

08/21/2018  |  By: Terri Mangrum, Flexible Compensation & Compliance Manager

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By: Logan Frost & Terri Mangrum

If you’ve ever been covered by medical insurance, you know that network providers are a moving target. One day, they’re in, and, the next day, they’re out. On September 1, 2018, members covered by BlueCross BlueShield of Tennessee will see movement from two significant providers. Covered participants aware of these two provider changes will be better equipped to make more cost-effective healthcare choices.

University of Tennessee Medical Center—They are IN!

The University of Tennessee Medical Center and affiliated practitioners will be in-network for all Blue Network S Plan enrollees on September 1st. The UT Medical Center has not been in BCBST’s Network S Plan since March 1, 2016.

Currently, the UT Medical Center accepts the Blue Network P. People with Network S insurance plans can still use UT Medical Center facilities and providers, but they may have to pay more. Health plans have negotiated reimbursement rates for in-network providers and may not pay as much to out-of-network providers, which can then bill patients for the difference. This is good news to our East Tennessee participants, as the move will now allow the Blue Network S to be considered in-network at the UT Medical Center starting on September 1st.

Anesthesia Medical Group—They are OUT!

BlueCross BlueShield of Tennessee and Anesthesia Medical Group (AMG) have parted ways after failing to reach an agreement on contracting rates for anesthesiologists. Because of the disagreement, AMG will leave BCBST commercial networks on September 1, 2018, but they will continue to practice at facilities that are in BCBST networks.

Even though hospitals—and the providers employed by them—will be in-network, the anesthesiologists employed by AMG who work in those facilities would not be covered to the same extent. Thus, patients who can’t choose the anesthesiologist could receive a balance or a surprise bill, as those anesthesiologists would be considered out-of-network.

AMG is one of the largest anesthesia providers in the mid-state, and this decision will impact many patients who are covered under BCBST insurance. Certain hospitals like Vanderbilt University Medical Center will, however, not be impacted, because they do not contract out anesthesiologists. Other hospitals are contracting with additional anesthesia providers to fill the void.

Before scheduling surgery or other services that require anesthesia, we're encouraging members to ask their doctors or hospitals to confirm who will provide anesthesia services and make sure they are in-network.

If you have questions or need more information about this network change, please contact LBMC Employment Partners, LLC. You may also visit www.BCBSTupdates.com to learn more about this issue.

BlueCross BlueShield Network Providers: Are you in? Or, are you out?

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