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Why we’re removing AMG from our provider network

Key Takeaways

  • After more than a year of negotiation, BlueCross is removing Anesthesia Medical Group (AMG) from commercial networks effective Sept. 1, 2018.
  • This change does not impact BlueAdvantage PPO, BlueCare Plus or BlueCare Tennessee plans.
  • We’ve offered rates we believe are both fair to them and affordable for our employer groups and members.
  • We will advocate on behalf of members who are billed incorrectly or inappropriately as a result of this change.

At BlueCross, ensuring our members have access to high-quality, affordable health care is our core business. One of our primary roles is to advocate for lower costs on behalf of our members, which we accomplish by negotiating price discounts with health care providers. Those discounts are passed on to our customers.

When our members have a surgical procedure – whether inpatient or outpatient – that requires anesthesia, we want to ensure the rates they’re being charged for that care are reasonable.

For more than a year, our team has attempted to reach an agreement on rates with Anesthesia Medical Group (AMG), which provides anesthesia coverage at hospitals and outpatient centers throughout Middle Tennessee, including the below facilities:

  • Saint Thomas Midtown Hospital*
  • Saint Thomas Hospital for Specialty Services* (formerly Saint Thomas Hospital for Spinal Surgery)
  • Saint Thomas West Hospital*
  • Sumner Regional Medical Center
  • Tennova Healthcare – Clarksville
  • Tennova Healthcare – Lebanon
  • The Children’s Hospital at TriStar Centennial
  • TriStar Ashland City Medical Center
  • TriStar Centennial Medical Center
  • TriStar Hendersonville Hospital
  • TriStar Horizon Medical Center
  • TriStar Skyline Medical Center
  • TriStar Summit Medical Center
  • Williamson Medical Center
*Other anesthesia providers may be available. Please call the hospital to confirm before getting any elective procedures.

Our contract offer would still have paid them more than they receive from the federal government while representing a significant savings on behalf of our members.

We are committed to negotiating savings because we know that unless we help control the cost of medical services like anesthesia, health care costs will continue to increase – along with our members’ out-of-pocket costs.

With AMG, we have tried to find a rate that’s both fair to them and affordable for our employer groups and members.

What we are doing to prevent major anesthesia bills from AMG

We have reached out to hospitals and providers in the middle Tennessee area to make them aware of the situation and enlist their help in finding alternative care options for members who require anesthesia services. Our prior authorization process can also help keep members from receiving care from an AMG provider for planned and elective procedures.

What you can do:

    • If possible, call BlueCross before your surgery
      If you’re planning on having inpatient or outpatient surgery on or after Sept. 1, call the number on the back of your insurance card before your procedure. Our customer service team can help guide you and your physician to an in-network facility that does not use AMG services.
    • In case of emergency
      Members who have a true emergency should always go to their closest facility. If you have emergency surgery that requires care from an AMG anesthesiology provider, there is a chance that they will bill you for the difference between what we will pay and what they charge. This is known as balance billing. If you are balance billed by AMG, reach out to us and we will work to help lower your costs.

We are committed to serving our members, and helping ensure they get the care they need at reasonable rates. Our efforts to negotiate with providers can help lessen the need for future increases in premiums due to high medical costs. 

About Marc Barclay, Senior Vice President, Provider Network Management

A photo of the authorMarc leads a team focused on strengthening our statewide provider networks, which ensure BlueCross members have affordable access to high-quality care.

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