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LifeBrite Community Hospital of Stokes Is Out Of The Blue Cross NC Network

LifeBrite Community Hospital of Stokes is out of the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) network (effective August 21, 2018).

In legal claims filed on May 16, 2018, Blue Cross NC asserted that “LifeBrite has engaged in a fraudulent scheme to enrich itself at Blue Cross NC’s expense by billing for laboratory services that were not payable, were fraudulent, were in violation of Blue Cross NC’s contracts with LifeBrite, and were otherwise unlawful.”


   

 

Which customers will be affected by this termination?

This cancellation affects commercial individual and group customers, Federal Employee Plan customers, State Health Plan customers and Blue Medicare HMO/PPOSM (Medicare Advantage) customers. It does not affect Blue Medicare SupplementSM and Blue Medicare RXSM customers.

Does this termination affect any physician office contracts?

For Medicare Advantage customers, this termination includes doctors in the LifeBrite physician network.  For all other customers, the termination does not include doctors in the LifeBrite physician network.  Non-Medicare Advantage customers can continue seeing these doctors at in-network rates at their practice or at other nearby in-network hospitals. LifeBrite doctors will not remain in-network for Medicare Advantage customers unless LifeBrite allows them to do so.

Additionally, many physicians at LifeBrite Community Hospital of Stokes also work at other nearby hospitals. This means customers may be able to continue seeing the same doctor at a different location.

Will Blue Cross NC process all of the lab claims submitted by LifeBrite Community Hospital of Stokes prior to the contract termination date? If not, will customers be responsible for the costs of those claims?

Claims for services provided by LifeBrite to Blue Cross NC members on or before August 21, 2018, will be processed (when eligible) as in-network for Blue Cross NC members. Blue Cross NC’s provider agreements state that in-network providers cannot bill a customer for more than the customer’s in-network responsibility.

After August 21, 2018, LifeBrite Community Hospital of Stokes will be an out-of-network provider. Any services provided by the hospital after that date will be considered out-of-network, and a customer’s out-of-network benefits will apply.

Does this only affect Blue Cross NC customers?

No. It also affects customers of other Blue Cross and Blue Shield plans whose lab claims were submitted to LifeBrite Community Hospital of Stokes. Several Blue Cross and Blue Shield plans have customers whose lab claims were submitted to LifeBrite Community Hospital of Stokes.

Where will LifeBrite Community Hospital of Stokes patients need to go when the contract ends on August 21, 2018?

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

Blue Cross NC customers in the Stokes County area seeking local, in-network care can use the following resources:

  • To find the closest in-network hospitals and doctors, use our interactive map of provider locations.
  • To find an in-network provider, customers can also use our Find a Doctor tool.
  • Call the 1-800 number on the back of their ID card.
  • Blue Cross NC customers can find urgent care and primary care options in Stokes and surrounding counties visiting bcbsnc.com

Can I keep using LifeBrite Community Hospital of Stokes facilities after August 21?

If you have a plan with out-of-network benefits, you can receive benefits for services at LifeBrite Community Hospital of Stokes for non-emergency care (not part of a Continuity of Care plan), but:

  • You will pay more money for that care. And usually, the price is much higher than you would pay at an in-network facility.
  • Blue Cross NC will pay you for the allowed amount of your care, and you will be responsible for paying the healthcare provider.

Many physicians at LifeBrite Community Hospital of Stokes also work at other nearby hospitals. This means customers may be able to continue seeing the same doctor at a different location, and in-network benefits will apply.

For Medicare Advantage customers, this termination includes doctors in the LifeBrite physician network.  For all other customers, the termination does not include doctors in the LifeBrite physician network.  Non-Medicare Advantage customers can continue seeing these doctors at in-network rates at their practice or at other nearby in-network hospitals. LifeBrite doctors will not remain in-network for Medicare Advantage customers unless LifeBrite allows them to do so.

Where should patients who are pregnant or seeking treatment for an ongoing illness go for care?

Customers who are pregnant or have a chronic medical condition may qualify for Blue Cross NC’s Continuity of Care program. Blue Cross NC will contact customers who may qualify for the continuity of care program.

If approved, customers may be able to continue seeing their current doctors at LifeBrite Community Hospital of Stokes for a period of time without paying higher out-of-network fees. Customers who have questions about the Continuity of Care program should call the number on the back of their membership ID cards.

How does this termination affect Blue Medicare HMOSM and Blue Medicare PPOSM (Medicare Advantage) customers?

Blue Medicare HMO and Blue Medicare PPO (Medicare Advantage) customers are also affected by this contract termination. LifeBrite Community Hospital of Stokes and LifeBrite physicians will be out of network beginning August 21 for these customers.

How does this termination affect Blue Medicare SupplementSM and Blue Medicare RXSM customers?

This termination does not affect Blue Medicare SupplementSM and Blue Medicare RXSM customers.

What is Blue Cross NC doing to help customers transition to a new in-network hospital?

Blue Cross NC will mail information to affected customers about the end of the contract with LifeBrite Community Hospital of Stokes, as well as information about alternate facilities where they can receive high-quality care.

In the meantime, customers with questions should call the number on the back of their membership ID cards.

What other in-network hospitals can I visit nearby?

Customers in the area seeking local, in-network hospital care should visit these surrounding hospitals:

   

  • UNC High Point Regional Hospital, High Point, NC
  • UNC Rockingham Healthcare, Eden NC
  • Novant Health Forsyth Medical Center, Winston Salem, NC
  • Novant Health Kernersville Medical Center, Kernersville NC
  • Novant Health Medical Park Hospital, Winston Salem, NC
  • Novant Health Thomasville Medical Center, Thomasville, NC
  • Wake Forest Baptist – Davie County Hospital, Bermuda Run, NC
  • Wake Forest Baptist – Lexington Memorial Hospital Davidson, Lexington, NC
  • Wake Forest Baptist – North Carolina Baptist Hospitals, Winston Salem, NC
  • Moses H. Cone Hospital – Moses H Cone Memorial Hospital, Greensboro, NC
  • Moses H. Cone Memorial Hospital – The Women’s Hospital of Greensboro, Greensboro, NC
  • Moses H. Cone Memorial Hospital – Wesley Long Community Hospital, NC
  • Moses H. Memorial Cone Hospital – Annie Penn Hospital, Reidsville, NC
  • Hugh Chatham Memorial Hospital, Elkin, NC
  • Northern Hospital of Surry, Mount Airy, NC
  • Randolph Hospital, Asheboro, NC
  • Sovah Martinsville Mem Hospital, Martinsville, VA


 

   

Why is Blue Cross and Blue Shield of North Carolina (Blue Cross NC) terminating its contract with LifeBrite Community Hospital of Stokes?

Blue Cross NC terminated its contact with LifeBrite under the contract 90-day termination clause, which allows customers time to find new, in-network doctors and reschedule any planned procedures.

What is the basis of Blue Cross NC’s lawsuit against LifeBrite Community Hospital of Stokes?

In legal claims filed on May 16, 2018, Blue Cross NC asserted:

“LifeBrite has engaged in a fraudulent scheme to enrich itself at Blue Cross NC’s expense by billing for laboratory services that were not payable, were fraudulent, were in violation of Blue Cross NC’s contracts with LifeBrite, and were otherwise unlawful.”

“The testing billed by LifeBrite was not for patients being treated at LifeBrite or for patients who resided in the relatively small territory covered by LifeBrite. Their only connection to LifeBrite was that their urine testing was billed through LifeBrite in order to take advantage of LifeBrite’s participating status and favorable reimbursement rate with Blue Cross NC.”

“Had the claims been billed directly by the Pass-Through Labs, most never would have been paid by Blue Cross NC, and those that were paid would have been paid at substantially lower rates.”

What does Blue Cross NC’s claims data show?

Since LifeBrite took over management of the Stokes County hospital from Pioneer, the previous management company:

  • Lab billing jumped more than 22,000 percent – from an average of $37,400 a month to $8.5 million a month.
  • The reported number of lab tests being done at the hospital jumped more than 24,000 percent – from an average of 267 a month to 67,000 a month.
  • The LifeBrite management group has submitted more than 525,000 lab tests, and billed more than $74 million, for people who do not appear to live in North Carolina, and who were never patients at the Stokes County hospital.

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Can you tell me more about LifeBrite Community Hospital of Stokes’ billing practices?

The issue with the management at LifeBrite Community Hospital of Stokes centers on billing practices for lab tests.

In its lawsuit, Blue Cross NC contends:

“LifeBrite used its status under the Contracts to bill for drug testing performed by other laboratories as if the testing had been performed at and by LifeBrite.”

“The testing billed by LifeBrite was not for patients being treated at LifeBrite, or by LifeBrite-credentialed healthcare providers, or for patients who resided in the relatively small territory covered by LifeBrite. Instead, LifeBrite operated as a pass-through, through which LifeBrite submitted reimbursement claims for the testing of Blue Cross Blue Shield members located across the United States.”

 “The vast majority of the patients were never present at LifeBrite, were never treated by LifeBrite-credentialed healthcare providers, and were located in areas not serviced by LifeBrite. Instead, their only connection to LifeBrite was that their urine testing was billed through LifeBrite in order to take advantage of LifeBrite’s participating status and favorable reimbursement rate with Blue Cross NC.”

 “Had the claims been billed directly by the Pass-Through Labs, most never would have been paid by Blue Cross NC, and those that were paid would have been paid at substantially lower rates.”

  

Why did Blue Cross NC reimburse more for lab tests done by LifeBrite Community Hospital of Stokes than for lab tests done at independent (“pass-through”) labs?

Blue Cross NC reimburses rural hospitals for lab tests at much higher rates than they reimburse independent labs. The negotiated rates take into account a number of factors, including Blue Cross NC’s desire to support rural hospitals in their effort to provide care to their patients.

An independent licensee of the Blue Cross and Blue Shield Association.® and SM Marks of the Blue Cross and Blue Shield Association.