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Done Deal: As of today, Mission Health is out-of-network with Blue Cross and Blue Shield

Effective today, October 5, 2017, Mission Health’s contract with Blue Cross has expired and essentially all Mission Health physicians and facilities are now out-of-network providers with Blue Cross and Blue Shield of North Carolina (BCBSNC). (Photo credit: WLOS Staff)

Effective today, October 5, 2017, Mission Health’s contract with Blue Cross has expired and essentially all Mission Health physicians and facilities are now out-of-network providers with Blue Cross and Blue Shield of North Carolina (BCBSNC).

Important exceptions to Mission Health being out of network include:

  • Emergency care, which always remains in network regardless of our network status with BCBSNC;
  • Blue Cross Federal employees who will remain in network until November 16th;
  • Care for patients with certain conditions who qualify for Continuity of Care;
  • Care for patients whose care would otherwise be unduly delayed because of a lack of access to physicians or facilities without Mission Health;
  • CarePartners physical therapy services, which go out of network on March 3, 2018; and
  • Services related to Blue Cross Medicare Supplement health plans.

BCBSNC members who purchased health insurance coverage on the Affordable Care Act exchanges will also be out of network.

BCBS released a statement Wednesday night re-iterating that Mission is the only health care system in the state to go out-of-network from BCBS due to the contract dispute.

Emergency care and some specialty services will remain in network as required by law. For many of our patients, Mission providers are the only reasonable choice due to the patient’s condition. Mission will assist those patients to use the legal protections available to them if BCBSNC refuses to follow state and federal law. Patients with questions should call the dedicated information line at (828) 417-0480 or visit MissionStandsWithYou.org.

Patients with ongoing special conditions, including acute illness, chronic illness, pregnancy or a terminal illness insured by BCBSNC may continue receiving care from an out-of-network provider through Continuity of Care. Patients can learn more about who may qualify and how to apply by visiting MissionStandsWithYou.org.

Blue Cross NC customers can visit bcbsnc.com/findadoctor to locate in-network doctors and hospitals in their area.

In Western North Carolina, this includes:

  • 10 Hospitals
  • 95+ Maternity Providers
  • 160+ Family Care Providers
  • 65+ Pediatric Providers
  • 120+ Urgent Care Providers
  • 70+ Orthopedic Providers
  • 5 Ambulatory Surgical Centers
  • 35+ Radiation/Imaging Facilities

Most Blue Cross NC plans allow customers to receive covered services from out-of-network providers. However, customers typically must pay higher out-of-pocket costs for out-of-network care.

In case of an emergency, Blue Cross NC customers should go to the nearest hospital, including Mission Health’s emergency rooms. Emergency care is always covered as an in-network benefit. Prior authorization is never required for emergency care.

Customers who are pregnant or have a chronic medical condition may qualify for Blue Cross NC’s Continuity of Care program. Customers who have questions about the Continuity of Care program should call the number on the back of their membership ID cards. Blue Cross NC has already approved hundreds of customers for Continuity of Care. This enables them to continue getting in-network coverage through their Mission Health doctors and facilities.

Any other services at a Mission Health facility performed on or after Oct. 5 will be considered out-of-network. If a customer is admitted to a Mission Health hospital before Oct. 5 and discharged after Oct. 5, this will be processed as in-network.

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