Mission Health Medicare Customer FAQs

Mission Health (Mission) has chosen to leave the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) network and is now out-of-network (as of October 5, 2017). This includes Mission Health Hospitals, Outpatient facilities, and most healthcare doctors. Some Mission healthcare providers (mostly therapists) may stay in-network until March 2, 2018.  You should contact Mission to see when your doctor is leaving the network.

I have a Blue Cross NC Medicare plan. Does this affect me?

This cancellation affects Blue Medicare HMO/PPOSM (Medicare Advantage) customers. It does not affect Blue Medicare SupplementSM and Blue Medicare RXSM customers.

I have a Blue Medicare HMO product. How does this affect me?

For Blue Medicare HMO, you must use in-network providers, except in emergency/urgent care situations, or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers, neither Original Medicare nor Blue Medicare HMO is responsible for the costs.

I have a Blue Medicare PPO product. How does this affect me?

  • Member liability with Blue Medicare PPO may be greater for services received out of network than services received in network.
  • Many out-of-network services are subject to coinsurance, which is based on the Medicare allowed amount and not on the potentially lower contract amount.
  • With the exception of emergency or urgent care, it may cost more to get care from non-plan or non-preferred providers.
  • Out-of-network/non-contracted providers are under no obligation to treat Blue Cross NC members, except in emergency situations.
  • For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service.

How can I get more information on my specific situation?

Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.