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Mission Health System will return to Blue Cross NC’s network as of Dec. 15

Blue Cross and Blue Shield of North Carolina (“Blue Cross NC”) and Mission Health have entered into an agreement for Mission Health provider participation in Blue Cross NC networks effective December 15, 2017.  Both parties are pleased to reach agreement on the mutual goal of ensuring that the people of Western North Carolina receive the affordable, quality health care that they need. 

Blue Cross NC remains firmly committed to all of our customers, and to ensuring they have access to high-quality, more affordable health care.

Until Dec. 15, services and care received after Oct. 5 will generally be processed as out-of-network.

When will Mission Health be back in Blue Cross NC’s network?

Mission Health will be back in the Blue Cross NC network effective Dec. 15. This means that on Dec. 15 Blue Cross NC customers can resume receiving in-network care at Mission Health facilities and with Mission Health providers. Please note that services and care received between Oct. 5 and Dec. 15 will generally be processed as out-of-network, unless it is an emergency or approved through the Continuity of Care program.

Why is there a delay in Mission Health returning to Blue Cross NC’s network?

If a provider terminates its Blue Cross NC contracts for an extended period of time, then Blue Cross NC has certain legal, regulatory, and systematic updates that it must undertake.  Those updates take some time and should be complete by Dec. 15.

Where can I go for in-network care until Mission Health is back in-network?

In an emergency, Blue Cross NC customers should always go to the nearest hospital. Emergency care is always covered as an in-network benefit. Prior authorization is never required for emergency care. If an admission to the hospital is medically necessary after an emergency room visit at a Mission Health facility, we will process these benefits as in-network.

Blue Cross NC customers in Western North Carolina should go to the hospitals listed on the map below for in-network care. You may also download a PDF Map for a comprehensive list of all in-network hospitals and surgery centers in the area, including Georgia, South Carolina, and Tennessee.  We suggest using our Find a Doctor Search Tool which is updated often.   

Can I continue to use Mission Health doctors and facilities?

After December 15, yes.  Until December 15, in certain situations, customers may continue to use Mission Health doctors and facilities as part of their in-network benefits.

  • In an emergency, Blue Cross NC customers should always go to the nearest hospital. Emergency care is always covered as an in-network benefit. Prior authorization is never required for emergency care.
  • Customers already in a treatment plan for certain conditions at a Mission Health facility may be able to keep receiving treatments as part of our Continuity of Care program. If you have previously been approved for this program, you should have been notified by us. 
  • Our customers can also go to urgent care facilities for urgent, non-emergency care, and most independent physicians in the area also participate in our network. To find an urgent care or primary care provider near you, go to bcbsnc.com.
  • If you have a plan with out-of-network benefits, you can receive benefits for services at a Mission Health healthcare provider for non-emergency care (not part of an approved Continuity Care request), but: 

 

  • You may 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 health care provider. 

I am a member of another Blue Cross plan, but I live in North Carolina. How does this affect me?

  • Mission Health hospitals and providers will be in-network for members of all Blue Cross plans as of Dec. 15.
  • Mission Health services and health care provider visits until Dec. 15 will generally still be processed as out-of-network.
  • When you visit hospitals, doctors and other facilities in North Carolina, you are using the Blue Card®.
  • Blue Card allows members of a Blue Cross and Blue Shield plan to get in-network care while traveling or living in another Blue Cross and Blue Shield Plan’s service area.
  • How members of other Blue Cross and Blue Shield plans can find in-network providers in NC until Dec. 15:
    • Call the Customer Service number on your Blue Cross Blue Shield member ID card
    • Use the provider search tool available from your local Blue Cross and Blue Shield plan’s website
    • Use the “Find a Doctor” provider search tool at bcbsnc.com

How does this affect Blue Medicare HMO, Blue Medicare PPO (Medicare Advantage) customers?

All Blue Medicare customers can resume receiving care at Mission Health facilities and with Mission Health providers on an in-network basis as of Dec. 15. Mission Health services and health care provider visits until Dec. 15 will generally still be processed as out-of-network.

How does this affect Medicare Supplement customers?

Medicare Supplement customers were not affected by the network termination. Medicare Supplement customers are not required to use a defined network of providers.

Will this happen again?

It is unusual for a hospital to terminate a contract as it signals the end of negotiations. While we cannot promise that a situation like this will not happen again, we can promise that we will continue to fight to make health care more affordable for our customers. 

Where can I get answers to other questions?

You may contact customer service using the phone number listed on the back of your card or login to the Blue ConnectSM Member Site and submit your question.  

*Mission Health’s independent reference lab will not be in-network, except for Medicare Advantage customers.

 

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