BCBSGA-Piedmont

I'm really surprised that there's been little written over the fact that the BCBCGA contract with Piedmont expired 6/30/06. Has anyone found a suitable hospital for care needs in the Fayette County area now that Piedmont is no longer a network provider option?

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PTC Guy's picture
Submitted by PTC Guy on Fri, 07/07/2006 - 10:37am.

This might have been answered already and I missed it.

We have heard, from a number of doctors and other sources, that Piedmont change way more than other hospitals. And that at times their services are not that good.

To be honest, we had one use of the emergency room. It was less than satisfying.

Can anyone nail down the realities of this compared to, say, Newnan?

Thanks.

-----------------------------
Keeping it real and to the core of the issue, not the peripherals.


Submitted by mlc2028 on Tue, 07/04/2006 - 10:21am.

I guess it was tacky for me to ask the Piedmont ladies (who were handing out popsicles to everyone) at today's PTC 4th parade "If I'm a BCBSGA member can I get a popsicle like everyone else?"

muddle's picture
Submitted by muddle on Tue, 07/04/2006 - 5:24am.

I've had BCBSGA for years, but my employer switched us to Kaiser on July 1st. BCBSGA offered *outstanding* coverage when I went thtough cancer treatment. I'm very concerned about this switch.

The worst thing is that, like John, I find myself having to switch doctors. In my case it is my primary care physician, Dr. Charles Bergstrom. His thoroughness in insisting on a PSA test years before most people have it done may well have saved my life, according to the doctor who administered my treatment.

The crazy thing, though, is that it turns out that Piedmont will be in Kaiser's "tier one" network, which is supposed to mean pretty good coverage. Our employer made the insurance switch oblivious to any falling out between BCBSGA and Piedmont.

I do hope they can iron out their differences for the sake of the many people in the area who are left out in the cold.


All Smiles's picture
Submitted by All Smiles on Tue, 07/04/2006 - 7:37am.

I have Kaiser/MultiChoice. Meaning I can go to a Kaiser facility and my co-pay will be just 5 or 10 dollars. Or I can stay around here and my co-pay will be either 10 or 20 dollars. (dependant on a specialist). My family and I see providers here. I take my children to the pediatricians at Fayette Medical, both my husband and I see Dr. Jim Sams. In addition, some of our family members see a dermatologist, a GI doctor, an endocrinologist, and even a plastic surgeon to have some moles removed all here in Fayette County and WITHOUT pre-approvals or referral slips! The ONLY problem I have run into, is when we visit a new doctor (specialist) many of the people working at the front dest hear "Kaiser" and are quick to jump saying, "We do not not participate in Kaiser." I am ready and pull out the what I printed off the insurance web site with that doctors information stating they are participating providers. One doctor's office insisted they were not participating so instead of fighting, I paid for the visit up front and filed the claim myself only for the payment to go to the provider as participating. Then, they understand they ARE participating and from then forward, I just pay my co-pay. In addition, I get all of our prescriptions here.
EVERY time I have had to call customer service at Kaiser, called member services, they are very helpful and extremely pleasant!! My bet is that you will not want to return to BC/BS! I don't!
(Sorry, neither one of them pays for vet bills.)


muddle's picture
Submitted by muddle on Tue, 07/04/2006 - 8:08am.

I'm signed up for the multi-choice and hoping for the best.

Through a cancer support group website I've met lots of guys who had Kaiser and could not get the treatment they needed. With prostate cancer you could count on your fingers the number of genuine "centers of excellence" in the country. These guys were told, "Our doctors can provide that treatment so we won't pay for you to go to _______ (RCOG, Loma Linda, Mayo, Johns Hopkins, etc.)"

When you have a life-threatening illness like cancer, the difference between middling and excellent is vital.

But perhaps these guys only had the older HMO, which is notoriously restrictive.


All Smiles's picture
Submitted by All Smiles on Tue, 07/04/2006 - 10:33pm.

For Multi-Choice, look at your insurance card. On the top it will have CCN or PHCS. Do a google search for the one which is on your card. Then you can check and maybe, by the grace of God, your doctor will be listed and you will not have to change. I know when I was checking all of the providers, I was VERY surprised to see so many doctors names I already knew. I hate the "Old HMO's" but I sure do like the Multi-Choice!!! Keep us updated!


Submitted by Sailon on Tue, 07/04/2006 - 8:04am.

Apparently everyone thinks BC should automatically pay Piedmont more than last time. Why? How much more? Why don't we know, after all eventually we pay for it. Companies don't pay more now---they are fed up--we will have to pay more out of our paycheck. Why is the overhead so high at a hospital? Anybody ever ask or does the hospital ever tell us? No. It is time to clamp down more on hospital costs, not for patient care, all other costs. Doctors make enough and administrators make too much, and there are too many who aren't efficient.

Submitted by Xcheerleader on Thu, 07/06/2006 - 9:13pm.

Check out how much the CEO of Blue Cross/Blue Shield of GA and other high up execs made last year. Doctor's and Administrators make peanuts compared to these insurance company executives. It's the insurance companies who are the cause of this. You are going to end up paying more for health care because of the giant insurance companies screwing you over. Compare the profits of BCBS of GA and the profits of area hospitals.

I'm glad Piedmont Fayette is taking a stand against the greed of BCBS of GA. The other hospitals should follow suit.

All Smiles's picture
Submitted by All Smiles on Fri, 07/07/2006 - 8:29am.

It's about time that a large group, Piedmont, stands up to an insurance giant like BC/BS!!! For many years, it has been the insurance companies which have dictated the type of treatment, when and how it would be delivered to the patient, you, the policy holder. Many times, the insurance companies decisions on how the doctor would treat the patient would not coincide with many guidelines set by groups such as the American Heart Assosciation, not to mention textbooks and the knowledge obtained in medical school.
I am aware insurance companies employee medical doctors, but for the most part, insurance administrators and their employees do not have a medical degree. They are business people and they are in business to make money. And, boy do they make it!!!!!
The next time any of my family members or myself are sick or injured, I'd feel much better to know I'm being treated by the doctor and his medical knowledge rather by an insurance company which ALWAYS looks for the cheepest way out with no regards to me or my illness!!!

STAND YOUR GROUND DOCTORS AND HOSPITALS!!!!!!!


Submitted by Sailon on Fri, 07/07/2006 - 8:20am.

You are comparing a few BC execs with the total salary of thousands of doctors and administrators? Some people have no busines sense I suppose. There MUST be a cut-off of medical expenses or the government will simply take over. All doctors and administrators don't need to end up millionaires. If you think one thousand employees at Fayette Piedmont is efficient for 100 beds and an emergency room that is malfunctioning, then maybe Piedmont doesn't need to look at their own efficiency. Companies are tired of grossly being overcharged by hospitals. Employees now pay more for their own insurance percentage wise than they ever have. That is also why most businesses don't even help their employees with insurance, can not pay it. Look around at the hospital---even you can see wasted time and money if you will look---no one is running or sweating and the shrubbery looks excellent.

Submitted by Xcheerleader on Fri, 07/07/2006 - 9:49am.

Who are you talking about that does not have any business sense? You really should check out the way BC/BS of GA does business. They are part of a huge national company. I believe they are owned by Wellpoint Inc. They could care less about people in Fayette County Georgia. They make health care their business, and they are IN IT FOR THE MONEY. They are responsible for the medical expense waste. Making doctors and health care workers jump through hoops and distort medical practices so they can make more money.

Doctors and health care administrators need to be paid well for the jobs they do, and the training and expertise they must have. I would hope that all of my doctors are millionaires. If they had the brains and character to get through medical school. They deserve millions. That goes for the rest of the health care community as well. Most health care workers get into medicine because they care about people. Insurance companies are for the bottom line only.

Businesses can't afford to have full coverage on their employees because the insurance companies are charging such high premiums, the businesses will go broke paying them.

I've looked around at the Piedmont Hospital, I've been a patient. I would hope that in this "civilized" area that we live in that no one would be running around sweating while trying to care for me at the hospital. It's a beautiful hospital, and I had a good experience. I know many of the employees there. All are great people and hard workers.

John Munford's picture
Submitted by John Munford on Mon, 07/03/2006 - 11:23pm.

His name is Nimish N. Dhruva and he's with Cardiac Disease Specialists, which I believe is part of the Piedmont Physicians' Group.

The care was excellent and thorough (I had a balky heart rhythm that's under control with medicine for now). Also the bedside manner was outstanding from EVERYONE in that practice.

Having said that now I have to shop for a new cardiologist. Here's the wrinkle Blue Choice hasn't thought out: Those of us with serious health issues who have to change specialists are going to cost BIG BUCKS. Gone untreated, my shortness of breath and wacked-out heart rhythm could lead to a stroke and perhaps death.

My new cardiologist is not going to take this condition lightly and likely will want to run a new battery of tests to confirm that my heart is indeed healthy, etc. Liability issues looming, he's not about to rely on tests and data compiled by folks he doesn't know and trust.

Sure the hospital is to blame here too, but the inside dope I got is that Blue Choice wants to renegotiate this contract EVERY YEAR. Thereby putting all of us at their mercies and whims. Not a good business model, but Oh Wait I Forgot: they're just trying to maximize profits for shareholders, the corporate robber barons (and their platinum-diamond encrusted parachutes).

Still overall I am very thankful for modern medicine and for the fact that I had the shortness of breath that revealed my condition. I've got two kids to raise and having lost my dad at 15 I know how that can really set a child back.

Now if I could just get myself back into shape and off the donuts, maybe just maybe I can get them through college.


bad_ptc's picture
Submitted by bad_ptc on Mon, 07/03/2006 - 10:38pm.

My doctor has his practice here in PTC and is accredited, not sure if that’s the correct word, to operate in Fayette Community and both of the Newnan hospitals.

When I needed two back to back surgeries he had me go to Newnan as he was no longer comfortable working at Fayette Community.

P.S. He also told me that the problem with BC/BS was coming, over a year ago, so it was no surprise to him that this has happened.


PTC Guy's picture
Submitted by PTC Guy on Mon, 07/03/2006 - 10:24pm.

Those with policies that allow can still charge under Out of Network.

That means they just effectively got a big premium increase.

I see none of our doctors are still on the Network list.

-----------------------------
Keeping it real and to the core of the issue, not the peripherals.


Submitted by skyspy on Mon, 07/03/2006 - 8:45pm.

I have BC/BS and will not miss Piedmont. The last surgery was a horror story(I am talking about the main hospital) I have heard horrible stories about our local hospitals' ER. Two different friends on two seperate occasions had to get care somwhere else quickly, both almost died; one called 911 while they were there,(in the ER) and the other had her husband drive her to Emory. Poor care won't be missed.

ImJustSaying's picture
Submitted by ImJustSaying on Tue, 07/04/2006 - 11:10am.

I think I remember you from the hospital. You were the uninformed one causing a scene by involving yourself in other people's healthcare decisions. I've heard of people using our emergency 911 service as a taxi ride provider. Was that your friend? Do you think your friend would recognize superior care if it happened to them? Would you?
Thanks for shopping Fayette.


Submitted by skyspy on Tue, 07/04/2006 - 3:38pm.

My friend is a paramedic for another county his child was 15 at the time of the emergency. When the staff or whatever they are, did not react appropriately or at all; he flagged down 2 guys going back into service. They took her to Childrens Health Care she had a collapsed lung.
I seriously would only use our local ER if you are sure it is just a sprain...and bring your own ice.

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