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:
- 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 terminates 12/31/2020
- Anthem Blue Cross Blue Shield of Georgia (BCBS-GA) – PPO/ HMO/ Open Access/ POS www.bcbsga.com
- Centek Industries, Inc. www.centekindustries.com
- Cigna Healthcare – PPO/POS/ Open Access www.cigna.com
- City of Camilla www.sgbainc.com
- City of Pelham www.sgbainc.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)
- Diversified Benefit Administrators www.sgbainc.com
- Georgia State Health Benefit Plan- www.dch.georgia.gov/state-health-benefit-plan-shbp
- Mitchell County Board of Commissioners www.sgbainc.com
- Nova Net – PPO www.novanetppo.com
- Okinus, Inc. www.sgbainc.com
- Taylor Benefit Resources www.tbrtpa.com
- Thomasville National Bank www.tnbank.com
- Thomas University (America’s TPA dba HealthEZ)
- 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)
- Ambetter (Healthcare Exchange) (Thomas, Grady, Brooks and Mitchell Counties)
Attention Anthem BCBS Pathway Plan Members – Effective 12/31/2020, Archbold will no longer participate in the Anthem BCBS Pathway Network.
Anthem BCBSGA terminated John D. Archbold Memorial Hospital, Grady General Hospital, Brooks County Hospital, Mitchell County Hospital and Archbold Medical Group from the Pathway Network on the Healthcare Exchange. The marketplace Health Plan Open Enrollment will begin on Friday, November 1, 2020 to December 15, 2020. Please thoroughly review your options during Open Enrollment. Check to be sure your local physicians and hospitals are in the plan, otherwise, you will have to change physicians and will not be able to utilize Archbold services.
- Anthem Blue Cross Blue Shield of Georgia www.healthcare.gov
- Anthem Blue Cross Blue Shield- Individual/ Pathway/ Pathway (Thomas, Grady, Brooks counties only) – Effective 12/31/2020, Archbold will no longer participate in the Pathway Network
- Anthem Blue Cross Blue Shield- Small Group Health/Pathway Enhanced/ Pathway X Enhanced (Thomas, Grady, Brooks counties only) – Effective 12/31/2020, Archbold will no longer participate in the Pathway Network
Other Government Programs
Tricare Military www.tricare.mil
Optum, Veterans Administration Community Care Network – Effective 6/29/2020 – https://www.va.gov/COMMUNITYCARE/index.asp
Note: VA determines a Veteran’s eligibility to get care from a VA CNN provider, and which types of care the Veteran can receive.
VA will issue a referral to authorize a specific Standard Episode of Care (SEOC). Veterans must present a SEOC prior to receiving care from a community care provider.
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
- 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.