Patient Responsibilities

Not all Insurance Benefit Plan cover all health care services. It is important to contact your benefit plan representative to find out what your insurance covers and what your financial obligations are. There is a toll free telephone number located on the back of your insurance card. Please call the customer service or member services department listed on the back of your card to find out whether or not your insurance covers a particular health services or procedure you are having. If you do not have coverage for those services, you may be held responsible for a portion of or in some cases, the entire bill.

Check your IN-NETWORK coverage: An “in-network provider” is a provider that is contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates. These providers typically have the lowest copay and/or coinsurance amount.

Check your OUT of NETWORK coverage: An “out-of-network provider” is a provider who is not contracted with the health insurance plan. If you use an OUT of NETWORK Provider you will be have a higher financial obligation and may be responsible for the entire bill.

If you require additional assistance regarding your in-network benefits, out-of-network benefits, whether your provider is in-network or out-of-network, what procedures are covered and not covered, and what procedures need to be authorized, please contact your insurance company directly. There should be a toll free telephone number located on the back of your insurance card.

HEALTH PLANS ACCEPTED

Archbold Medical Center facilities and John D. Archbold Memorial Hospital are “in-network” and contracted providers with the following managed health care plans. These contracts cover most services provided at John D. Archbold Memorial Hospital, Brooks County Hospital, Grady General Hospital and Mitchell County Hospital and Archbold Medical Group.

If your health plan is not listed then Archbold Medical Center facilities may be “out-of-network” or may not be a contracted provider in your health plan. Please contact your health plan directly to see if higher out-of-pocket financial penalties apply when choosing a non-contracted “out-of-network” provider.

Medicare

Medicare Advantage Plans www.medicare.gov

For these plans Archbold facilities are considered IN – NETWORK:

For all other Medicare Advantage HMO and PPO plans, including Medicare Advantage Private Fee for Service (PFFS) plans, Archbold can accept patients covered by those plans but we are considered OUT OF NETWORK and the patient may have higher out of pocket costs. www.medicare.gov

Medicare-Supplemental Plan

  • We accept all Medicare Supplemental Plans
  • Tricare for Life (Medicare Supplemental) www.tricare.mil

Georgia Medicaid

Commercial Insurance (Group Health)

Health Insurance Marketplace (HealthCare Exchange)

  • Blue Cross Blue Shield of Georgia www.healthcare.gov
    • Blue Cross Blue Shield- Individual/ Pathway/ Pathway
    • Blue Cross Blue Shield- Small Group Health/Pathway Enhanced/ Pathway X Enhanced

Other Government Programs

GEORGIA WORKERS COMPENSATION

Behavioral Health

Archbold Northside Center for Behavioral and Psychiatric Care contracts in-network with the following behavioral and psychiatric managed care insurance plans:

NOTE: To find out which providers are in-network and accept your insurance, what your insurance plan benefit covers, what your financial obligation may be please call the customer service or member services department of your insurance company (the phone numbers are on the back of your insurance card). Your employer's human resources department may also be a source of information and assistance.