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 of Georgia Part A www.medicare.gov or www.cms.gov
- Medicare of Georgia Part B www.medicare.gov or www.cms.gov
Medicare Advantage Plans www.medicare.gov
For these plans Archbold facilities are considered IN – NETWORK:
- Care Improvement Plus www.careimprovementplus.com
- Georgia State Retiree Health Benefit Plan - www.dch.georgia.gov/state-health-benefit-plan-shbp
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
- We accept all Medicare Supplemental Plans
- Tricare for Life (Medicare Supplemental) www.tricare.mil
- Amerigroup www.amerigroup.com
- CareSource CMO
- Georgia Medicaid (DCH) www.dch.georgia.gov
- Peach State Health Plan www.pshpgeorgia.com
- Wellcare of Georgia www.georgia.wellcare.com
Therapy Network of Georgia (Wellcare Outpatient Therapy Services)
Commercial Insurance (Group Health)
- AMC - Claims (Archbold Employees)
- Aetna – PPO / Managed Choice POS / Choice POS II/ Select/Open Choice / National Advantage www.aetna.com
- Blue Cross Blue Shield - Prudent Buyer www.bcbsga.com
- Blue Cross Blue Shield – PPO/ HMO/ Open Access/ POS www.bcbsga.com
- Centek Industries, Inc. www.centekindustries.com
- Cigna Healthcare – PPO/POS/ Open Access www.cigna.com
- Coventry – National PPO/ First Health Network/ Southcare PPO www.coventry.com
- Note: Archbold does NOT participate in Coventry Health Care of Georgia, Inc. (HMO, POS, Open Access or PPO), Coventry One, Assurant Health Plus, Gwinnett Health System or Southern Regional Health System)
- Georgia State Health Benefit Plan- www.dch.georgia.gov/state-health-benefit-plan-shbp
- Nova Net – PPO www.novanetppo.com
- Taylor Benefit Resources www.tbrtpa.com
- Thomasville National Bank www.tnbank.com
- UnitedHealthcare - PPO www.uhc.com
- UHC - Golden Rule's/ Charter, Charter Balanced & Charter Plus/ Choice/ Choice Plus/ Core & Core Essentials/HMO/ Open Access/POS/PPO. UnitedHealthOneSM www.uhc.com
Health Insurance Marketplace (HealthCare Exchange)
- Blue Cross Blue Shield of Georgia www.healthcare.gov
- Blue Cross Blue Shield- Individual/ Pathway/ Pathway (Thomas, Grady, Brooks counties only)
- Blue Cross Blue Shield- Small Group Health/Pathway Enhanced/ Pathway X Enhanced (Thomas, Grady, Brooks counties only)
Other Government Programs
Tricare Military www.tricare.mil
GEORGIA WORKERS COMPENSATION
- Align Network www.alignnetworks.com
- Rockport United Network www.rockportnetwork.com
- One Call Medical (Radiology Services only) www.onecallmedicalcm.com
Archbold Northside Center for Behavioral and Psychiatric Care contracts in-network with the following behavioral and psychiatric managed care insurance plans:
- Aetna www.aetna.com
- BCBS – Georgia www.bcbsga.com
- Centpatico www.cenpatico.com
- Magellan www.magellanhealth.com
- Magellan-Navigator/ Pinnacle Network / Summit Network www.magellanhealth.com
- Managed HealthCare Administration (BC/BS-Alabama) www.mhcausa.com
- Summit Network www.thesummitnetwork.com
- United Behavioral Healthcare/UHB Optum Health www.uhc.com
- Value Options Tricare www.valueoptions.com/company/Federal.htm
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.