Blue Cross and Blue Shield of Georgia expands Medicare Advantage coverage : News : MySouthwestGA.com

BCBS of Georgia say in the release that Baldwin, Candler, Chattahoochee, Crawford, Emanuel, Evans, Fayette, Laurens, Monroe, Morgan, Stewart, Tattnall and Webster Counties are the new additions.

If a new contract is not reached before then, Blue Cross members would be out of network if they go to any of Tenet’s five hospitals in Georgia, all of which are in the Atlanta region: North Fulton Hospital, Atlanta Medical Center, South Fulton Medical Center, Spalding Regional Medical Center, and Sylvan Grove Hospital.

Blue Cross vs. Tenet: Will Someone Blink?

That would mean higher co-pays for patients using those hospitals.

With both sides saying they are trying to do the best thing for everyone, we can only wait and see what outcomes there are. But don't expect an early resolution, these things do tend to go to the 12th hour.

He turned the matter over to the fraud department of Blue Cross and Blue Shield of Georgia, which operated his Medicare Advantage health plan, which led to a staggering $1 million dollar fraud recovery.

Atlanta a new hotbed for medical fraud

The Atlanta area is a hotbed of health care fraud, says Lavelle, director of investigations for WellPoint’s health plans in the Central and Southeast regions.

Many perpetrators have moved to Georgia from the south Florida area, where health care fraud has been rampant and has drawn a heavy crackdown from law enforcement.

“Atlanta has so many hospitals, so many doctors, there’s an easy fit [for fraudulent providers] into the market,’’ says Lavelle.

“We have to stay as smart as the crooks,’’ she says. “We have to stay ahead of the curve. The crooks are getting smarter and better.’’

According a report by BCBS, Georgia has the second highest rate of childhood obesity in the US, with one in three kids (37.3 percent) in the state classified as obese. Almost half of children ages 10 to 14 fail to meet the recommended level of physical activity.

This is regarded as being an epidemic level of obesity and Blue Cross Blue Shield say that the health risks associated with obesity can lead to serious physical and emotional consequences for Georgia's children, including high blood pressure, diabetes and low self-esteem:

This has the effect of holding our children back and keeping them from reaching their true potential. Georgia’s youth deserve to be given the tools to live a happy and healthy life.

For hundreds of kids in Georgia, the 2011 Kids' Wheel and Run event marked the start of a program designed to get them walking, running and 'wheeling'.

Over 70 Kids finished the 5K event , sponsored by BCBS Ga, and held in November 20th 2011 at Piedmont Park.

The Healthy Kids Program is an initiative of Lt. Governor Casey Cagle, who opened the event.

“I am confident that with the right civic leadership and motivation across the state we can successfully change the culture surrounding health and physical fitness to create a healthier generation of Georgians.”

WellPoint Being Investigated by State | Georgia Public Broadcasting
“They have raised rates in the last two years an average of about 21-23% two years consecutively in Georgia.”

In California WellPoint withdrew a request for a 39% increase to its premiums after projected costs were deemed to be "unreasonable". Blue Cross sells nearly 70% of individual health insurance policies in Georgia. If the audit finds projected costs to be deemed unreasonable in Georgia, the rates will have to be adjusted and the company may be liable for fines.

The new Patient Protection and Affordable Care Act, with over 2,000 pages of new federal law, will touch virtually every facet of the health care industry.

BCBS have provided 2 documents for people to read so they can get more information on the health care reform bill. These are:

• "Impacts on Employers," an in-depth white paper regarding health care reform and


• "Key Health Care Reform Issues for Employers," a summarized version of the "Impacts on Employers" white paper

We are disappointed with today’s decision by the commissioner of insurance, which singles out Blue Cross and Blue Shield of Georgia ... for different treatment than other insurers," she said.

Blue Cross/Blue Shield is the state's largest insurer, representing 2.7 million Georgians. Oxendine said there are many areas of the state where hospitals, physicians and specialists have been denied entry into the insurer's system, thereby limiting people's health care options

However, the ruling does not limit the company's ability to negotiate a contract. If the two sides cannot agree on a contract, Blue Cross/Blue Shield has the right to deny the application.

Blue Cross and Blue Shield of Georgia (BCBSGA) and OneSight®, a Luxottica Group Foundation have teamed to bring a regional clinic to Georgia from Monday, March 22, through Friday, March 26. Clayton County, Henry County and Spalding County Schools pre-selected approximately 600 students from kindergarten through high school based on their financial and vision needs to receive free vision care, including full vision exams and new eyewear.



We tried talking to the management to understand why such decision was made and if they would reconsider changing their policies, but were not successful in getting a response. 

Many of our clients who hope to bring their parents into the U. S. to stay with them for extended periods may have to think twice if they are not eligible to obtain long term major medical benefits for them.

While BCBS of GA no longer offers health care for seniors without Medicare, there are global healthcare policies one can apply for which may cover immigrants in the U. S.  But it's a shame we had to lose one of our most trusted companies as a vendor for our customers.
 
Hopefully, some other health insurance carrier in GA will consider offering products to this under served senior market.

"Certainly in Georgia there are barriers," said June Deen, the director of advocacy for the lung association in Georgia and South Carolina. "We know a higher percentage of the Medicaid population smoked than the population at large. And we're one of a very few states that offer no service or treatment to those Medicaid recipients who wish to quit smoking. We also offer very little in the way of treatment to state employees who wish to quit smoking and they're a rather large employer in our state."

For those people in Georgia who want to stop smoking, you may have to go "cold turkey" if your health insurance company does not offer programs and support for nicotine therapy. Thankfully for those in the Atlanta area who are members of Blue Cross / Blue Shield can receive some assistance.