Information for Patients Blue Cross Blue Shield Health Plans

An Important Message for Our Patients Covered by Blue Cross Blue Shield Health Plans

As of July 23, 2017, Putnam North Family Medical Center providers are no longer in-network providers for Federal, BCBS PPO/POS and Traditional/PAR Plan health plans. This termination includes out of state Blue Cross Blue Shield plans. Our patients can continue coming to us using their outof-network benefits or other resources that they have available. We deeply regret the impact this has on our patients. However, the Putnam North Family Medical Center stands ready to care for our patients as we always have.

How do I know what BCBS plan I have? 
Please call the BCBS Member Services number on your ID card.

I have Blue Cross Blue Shield as my secondary insurance, does this mean I can no longer access the Putnam North Family Medical Center in-network?
According to the information provided by Blue Cross Blue Shield representatives, patients of The Putnam North Family Medical Center who have Blue Cross Blue Shield as their secondary insurance coverage are not affected by the BCBS termination. Whatever your primary payor is i.e., Aetna, Cigna, United Healthcare, etc., as long as you are in-network with the primary insurance you can continue to receive care from the Putnam North Family Medical Center. We will file claims with your secondary insurance, as applicable.

I’m a Federal Employee receiving benefits from Blue Cross Blue Shield, what are my options? Federal employees who would like to continue to receive health care services from their providers will need to use their out-of-network benefits.

What insurance plans does the Putnam North Family Medical Center accept?
The Putnam North Family Medical Center accepts all other major health insurance plans, including Aetna, HealthChoice, Cigna, United Healthcare and Humana, WebTPA, OSMA etc.

Why did BCBS terminate the Putnam North Family Medical Center from participating in its health plans?
While we cannot address decisions made by another organization, we can tell you that the Putnam North Family Medical Center received notice of termination and was dismissed from the PPO/POS and Traditional/PAR Plan networks. In an effort to narrow their network, BCBS exercised a contractual provision of its agreement with The Putnam North Family Medical Center, which permits one party to terminate the agreement without cause with 90 days advance notice. BCBS has made the decision to terminate The Putnam North Family Medical Center participation in all plan products offered by BCBS in accordance with that provision. Our practice was one of many affected across the nation.

Will negotiations with BCBS continue?
BCBS’s action to terminate and dismiss us from their PPO/POS and Traditional/PAR Plan network represents the final step in those negotiations. We remain open to negotiating with Blue Cross and hope one day to come to an agreement that is mutually pleasing and in the best interest of our patients. The Putnam North Family Medical Center greatly values the trust our patients place in us. Patients are welcome to continue their care at The Putnam North Family Medical Center by using their out-of-network benefit options, if applicable to their plan – and we will extend a 40% discount on all professional services provided.

Am I being dismissed as a Putnam North Family Medical Center patient?
No, your insurance is no longer contracted, but you are still a Putnam North Family Medical Center patient.

If I use my Out-of-Network Benefits, who will file my claims with Blue Cross?
The Putnam North Family Medical Center will continue to file your claim to Blue Cross Blue Shield.

Can you explain how the 40% off discount works when combined with out-of network charges?
The Putnam North Family Medical Center is extending a 40% discount to our patients that are impacted by Blue Cross Blue Shield’s termination of our contract and dismissal from their network. Below is an example of how the discount would be applied. The Putnam North Family Medical Center will continue to file claims on your behalf to Blue Cross as an added courtesy for our patients. Payment for services will be due at the time of service, as Blue Cross Blue Shield will send their payment directly to the patient.

(Example only)

The Putnam North Family Medical Center Charge:    $178.00
Courtesy Discount 40%:                                                      -$ 71.20
Amount Due to PNFMC                                                      $106.80
BCBS Payment:                                                                    -$ 64.75 (Note: This amount will vary from $0 to some percentage based on the fee-schedule of your plan and out-of-network benefits.)

                                                                          ————————————————
Patient Balance:                                                                $ 42.05

What if I don’t have out-of-network benefits or prefer to self-pay?
All patients are welcome to self-pay. We offer a self-pay discount on all services and charges for patients who do not use their insurance.

If I do not agree with the amount paid by Blue Cross Blue Shield when using out-of-network benefits, who will be responsible for discussing the concerns with BCBS?
You or the insured will need to work with BCBS on payment issues.

What can I do to access the Putnam North Family Medical Center again using in-network benefits?
We understand that this situation has created a lot of stress and upset many patients and we absolutely want to continue to care for our patients. At this time, the best option if you wish to continue to access the Putnam North Family Medical Center using in-network benefits would be at open enrollment, look for an option to select a plan with another insurance carrier we are in-network with, such as Aetna, Cigna, United Healthcare, OSMA or Humana, just to name a few.

Sincerely,

John Pittman, MD