Deal Between Blue Cross Blue Shield, Medical Center Falls Apart

Staff Report From Macon CEO

Tuesday, May 13th, 2014

Central Georgia Health System and its affiliated entities announced Monday that they are preparing for termination of their contracts with Blue Cross Blue Shield (BCBS). CGHS will continue to accept BCBS insurance, but will do so as an out-of-network provider as of May 15, 2014. Affected CGHS entities include: 

  • Central Georgia Health Network’s (CGHN) 841 providers
  • Central Georgia Rehabilitation Hospital
  • The Medical Center of Central Georgia
  • The Medical Center of Peach County

After almost nine months of negotiations with BCBS, CGHS announced on April 25 that it had reached a one year agreement with BCBS on a reimbursement structure for both the physician and hospital contracts, protecting in network status for CGHS and its affiliates. At that time, a notice of extension was filed to allow the involved parties to finalize the amendment language.

“While it has been our strong desire to continue our partnership with Blue Cross Blue Shield in order to continue providing care for Blue Cross Blue Shield patients in our community, the lack of effort invested by Blue Cross, one of the state’s largest health insurers, toward good faith resolution has seriously jeopardized our agreement. Regrettably, unless Blue Cross Blue Shield provides an acceptable amendment, their actions have left us with no choice but to prepare to terminate our contract,” said Rhonda Perry, Chief Financial Officer for CGHS.

Throughout the negotiation process, CGHS and CGHN offered to continue substantial discounts to BCBS in hopes of continuing the contract renewal seamlessly. However, the changing healthcare landscape required CGHS and CGHN to seek additional safeguards within the contract.

“At this time, the proposed terms we have received from Blue Cross Blue Shield are very different from the principles to which we had agreed on April 24, putting both the hospitals and physician network in extremely unfavorable positions. While we continue to work diligently to meet the objectives of our agreement, Blue Cross Blue Shield has failed to demonstrate a commitment to resolving the remaining contract issues, “ said Steve Barry, Chief Executive Officer of CGHN.

CGHS and CGHN strongly believe in providing the central Georgia community with a continuity of care.

“In order to achieve optimal patient care, we must address medical inflation and substantial declines in reimbursement. We are also sensitive to concerns about future premium increases and have kept our proposals well within range for the Georgia market,” said Perry.

CGHS has established a dedicated call center to address questions and concerns. The call center may be reached at (478) 633-8888 or for more information, please visit www.mccg.org. In spite of the potential contract termination, CGHS is committed to creating financial arrangements for out-of-network care during this transition period.