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Health Plans Accepted

Patient Responsibilities

Not all Insurance Benefit plans 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 particular health services or procedures 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 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

John D. Archbold Memorial Hospital, Archbold Northside Center for Behavioral and Psychiatric Health, Grady General Hospital, Brooks County Hospital, Mitchell County Hospital, Archbold Medical Group, Cardiovascular Consultants of South Georgia, Inc. and Archbold Medical Group Interventional Radiology are “in-network” and contracted providers with the following managed health care plans. These contracts cover most services provided at Archbold Medical Center facilities.

If your health plan is not listed then Archbold Medical Center facilities may be OUT OF NETWORK for 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 prior to services being rendered.

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. Oftentimes, Medicare Advantage HMOs do not provide coverage if a patient sees an OUT OF NETWORK provider which means the patient may be responsible for the entire bill.www.medicare.gov

Medicare-Supplemental Plan

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

Georgia Medicaid

Christian Health Cost Sharing Ministry

Christian Healthcare Ministries is a health cost-sharing ministry that is a federally certified exemption to the national healthcare law; eligible options for individuals and families for alternative healthcare.

Christian Healthcare Ministries (CHM), www.chministries.org

Commercial Insurance (Group Health)

Health Insurance Marketplace (HealthCare Exchange)

*Attention Anthem BCBS Pathway Plan Members* – Effective 1/1/2021, John D. Archbold Memorial Hospital, Grady General Hospital, Brooks County Hospital, Mitchell County Hospital, Archbold Medical Group, Cardiovascular Consultants of South Georgia, Inc. and Archbold Medical Group Interventional Radiology are OUT OF NETWORK with Anthem BCBS Healthcare Exchange Plans. All other Anthem BCBS plans remain IN-NETWORK.

Open enrollment for HealthCare Exchange Plans begins in November and ends in mid-December each year. Members who want to continue to utilize Archbold services, will need to check the list above to see the HealthCare Exchange Plans Archbold accepts.

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

Behavioral Health

In addition to the Health Plans listed above, Archbold Northside Center for Behavioral and Psychiatric Care accepts the following health plans that are specific to behavioral and psychiatric care:

NOTE: To find out which providers are in-network and accept your insurance, what your insurance plan benefit covers, and 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.

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