Wayne Memorial Hospital Situation
As you may have read in recent news reports, Wayne Memorial Hospital in Goldsboro, N.C. will no longer be in network for many Blue Cross and Blue Shield of North Carolina (BCBSNC) customers effective December 5, 2013. Unfortunately, we were unable to mutually agree upon terms after more than a year of contract discussions. We reached an impasse, which forced us to make this tough decision.
We understand that this decision may have an impact on your practices and your BCBSNC patients in the Goldsboro area, especially if you only have admitting privileges at Wayne Memorial Hospital. Our members in the Wayne County area will be receiving a letter from BCBSNC in the coming days that explains the situation, and we want to share some of the key messages with you too:
- Effective December 5, 2013, Wayne Memorial Hospital will no longer be in Blue Cross and Blue Shield of North Carolina’s network (includes State Health Plan and the Federal Employee Program). This does not apply to our Blue MedicareSM/Medicare Advantage network.
- In-network coverage for BCBSNC members who seek care at Wayne Memorial Hospital on or after December 5 will be limited to emergency care, care that is not reasonably available at other area hospitals, or for specific situations that are approved for eligible members who request continuity of care from BCBSNC.
- Any authorizations for approved, in-network services at Wayne Memorial Hospital made in advance of December 5 will be honored.
- There are 34 in-network hospitals within driving distance of Wayne County, and the five nearest hospitals are within a 30-mile radius of Goldsboro.
Continuity of Care Guidelines
It is the policy of BCBSNC to provide continuity of care to members who qualify for special ongoing conditions. For members to be eligible, one of the following conditions must apply:
- The member is in her second or third trimester of pregnancy or completing postpartum care. For members in their second or third trimester of pregnancy, the continuity of care period may last through the postpartum period.
- The member has an acute illness, which is a condition serious enough to require medical care or treatment to avoid a reasonable possibility of death or permanent harm. For members who have an acute illness or condition as described in this policy, the continuity of care period may extend up to 90 days.
- The member has a chronic illness or condition, which is a disease or condition that is life-threatening, degenerative, or disabling, and requires medical care or treatment over a prolonged period of time. For members who have a chronic illness or condition as described in this policy, the continuity of care period may extend up to 90 days.
- The member is terminally ill, which means the medical prognosis is that the individual's life expectancy is six months or less. For members who are terminally ill, continuity of care shall be in place for the remainder of the member’s life.
Continuity of care is only granted for 90 days or the end of the course of active treatment, whichever is less, unless noted above in the conditions.
If any of these ongoing special conditions apply to your BCBSNC patients, and they are already scheduled for procedures at Wayne Memorial Hospital, please direct them to call BCBSNC Customer Service at the number listed on their BCBSNC ID card. The patient should ask the BCBSNC Customer Service representative for the “Continuity of Care” request form to be sent to them. The patient should fill out the form, and return it to BCBSNC via the fax number noted on the form. The request will be reviewed by a nurse, and the patient will be contacted regarding their specific situation. Please note that this is not a guarantee of coverage at in-network rates.
If you have any questions about our continuity of care guidelines, please contact the Provider Blue LineSM at 1.800.214.4844.