Grady Health System Now Out-of-Network with Blue Cross Blue Shield

Atlanta's key trauma facility makes a commitment to protect patient access to lifesaving care

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Nov 25, 2014, 09:30 ET

ATLANTA, Nov. 25, 2014 /PRNewswire-USNewswire/ -- Grady Health System announced, after almost a year of negotiations, it has been forced out of the Blue Cross Blue Shield of Georgia (BCBSGA) network. Effective immediately Grady facilities are considered out of network for all BCBSGA patients, including Medicare Advantage and the Georgia State Health Benefit plan.

Despite Grady's numerous efforts to find compromise, a fair agreement was not reached prior to the contract termination date. Grady is one of the lowest paid hospitals by BCBSGA. A third-party analysis shows that BCBSGA pays Grady up to 70% less than other Georgia providers. Despite this staggering payment gap, BCBSGA failed to compromise with Grady and continued to offer rates significantly lower than those necessary to sustain Grady's lifesaving services.

"We are simply asking Blue Cross Blue Shield of Georgia to pay us fairly for the vital care we provide," said Lindsay Caulfield, Senior Vice President of Public Affairs at Grady. "Unfair low payments threaten our ability to maintain the high quality of care that our community relies on in their time of need."

Grady plays a unique and vital role in the community. The hospital is one of only two Level 1 trauma centers in North Georgia, one of only two burn centers in the entire state, and Georgia's most advanced and busiest stroke and neuroscience center. Fair payments from health insurance companies are essential to the hospital's long-term sustainability.

Grady remains committed to reaching an agreement with BCBSGA and restoring the community's access to the essential lifesaving care it provides, and to minimizing disruption to its patients.

BCBSGA members with questions regarding their plan's out-of-network benefits should contact BCBSGA by calling the Customer Service number on the back of their insurance card.

BCBSGA members with questions regarding their care at Grady are encouraged to call Grady's dedicated information line at (404) 487-6065.

About Grady Health System

Grady Health System is one of the largest safety net health systems in the United States. Grady consists of the 953-bed Grady Memorial Hospital, six neighborhood health centers, Crestview Health & Rehabilitation Center, and Children's Healthcare of Atlanta at Hughes Spalding, which is operated as a Children's affiliate.

With its nationally acclaimed emergency medical services, Grady has the premier level I trauma center in the Metro Atlanta region and serves as the 911 ambulance provider for the city of Atlanta. Grady's American Burn Association/American College of Surgeons verified Burn Center is one of only two in the state. And the Marcus Stroke and Neuroscience Center is a Joint Commission designated Advanced Comprehensive Stroke Center.

Other key services include Georgia's first Cancer Center for Excellence, The Avon Breast Health Center, the Georgia Comprehensive Sickle Cell Center, and the Ponce de Leon Center - one of the top three HIV/AIDS outpatient clinics in the country. Grady's Regional Perinatal Center with its Neonatal Intensive Care Unit, the Primary Care Center and the Rape Crisis Center are also notable components of the health system. The state's only Poison Center is housed at Grady as well.

In 2014 Hospitals & Health Networks Magazine again named Grady one of the country's Most Wired health systems. Grady's Heart Failure Clinic received the 2013 Gage Award for Improving Quality from America's Essential Hospitals.

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SOURCE Grady Health System