Questions remain about BCBS coverage and Mission

Questions remain about BCBS coverage and Mission


Brittney Lofthouse – Staff Writer

With Mission Health Systems and Blue Cross Blue Shield of North Carolina’s contract ending on Oct. 5, there are still lingering questions on what and who can receive “in-network” coverage.

Patients who are covered with BCBS can continue to see their current doctor and use Mission Health’s facilities as an out-of-network provider, which means those services would cost more. Some patients, those with ongoing special conditions, may be eligible for Continuity of Care.

If your primary care physician or specialist will be out of network with Blue Cross and they are currently treating you for an ongoing special condition that meets Blue Cross’s Continuity of Care criteria, you should have received a notification advising you of their Continuity of Care policy. If you did not receive a letter,you may call (828) 412-6363 to see if your special circumstances apply.

To be eligible for Continuity of Care, the patient must be seen by a participating provider (this includes hospital services) prior to the termination taking effect. The patient must be actively being seen by the out-of-network provider for an ongoing special condition and the provider must agree to abide by the Blue Cross’s requirements for Continuity of Care.

Ongoing special conditions, including acute illness, chronic illness, pregnancy or a terminal illness insured by Blue Cross may continue receiving care from an out-of-network provider through Continuity of Care.

Specific services for which Mission is the region’s only provider will still be considered in-network for many Blue Cross patients. Those services can be identified by contacting Mission Health Systems.

Services related to Blue Cross Medicare Supplement health plans will remain in network. BCBSNC Medicare Supplemental plans (also known as MediGap health plans) are not impacted. Even though Mission is out of network with BCBSNC, patients with BCBS Medicare Supplements will still have in-network access to all Mission providers.

BCBSNC members will always have access to all Mission Health Systems emergency rooms, regardless of the contract status with BCBSNC. If a patient experiences a medical emergency, they should always visit the nearest emergency room. Patients are entitled to in-network emergency care at any hospital until they are stabilized, and then any needed admission would require BCBSNC’s authorization.

For more information about coverage in the Mission Health System, call 828.213.1500 (select option 1) to speak with a customer service representative from 8 a.m to 4:30 p.m. Monday- Friday.