North Carolina Baptist Hospital Will Waive Out-of-Network “Penalties” for Blue Cross and Blue Shield Members

May 26, 2005

WINSTON-SALEM, N.C. – North Carolina Baptist Hospital will waive all financial “penalties” for patients who have Blue Cross and Blue Shield of North Carolina (BCBSNC) out-of-network benefits after the hospital’s contract with the insurance plan is terminated on June 4.

The waiver will be in effect for 90 days. This means that BCBSBC members with PPO (preferred provider organization) and POS (point of service) plans that provide out-of-network benefits will pay no more for their care and services at Baptist than they would as in-network patients.

The waiver applies to more than 90 percent of all BCBSNC members who use the hospital. It does not apply to the relatively small number of patients in a BCBSNC health maintenance organization (HMO) plan that provides no out-of-network benefits.

“This decision is being made to ensure that Blue Cross Blue Shield members are able to continue receiving care at Baptist Hospital conveniently and with no added financial burden,” said Len B. Preslar Jr., Baptist’s president and CEO.

“We wanted to say clearly to those patients that we are on their side in making sure that they get the best care possible, and that they get it in the easiest and most affordable way possible,” Preslar said. “We hope that this approach will clear up the confusion over who is affected and who is not affected by the termination of our Blue Cross Blue Shield contract.”

The waiver applies to patients who either have treatment or schedule future treatment within the 90-day time period.

Preslar said the time period was set to allow employers and individuals to explore alternative plans for continued access to Baptist Hospital on an in-network basis.

Many BCBSNC members will not need the out-of-network waiver because they will still qualify for in-network benefits – for emergency care, certain continuing care and certain specialized services.

Although the out-of-network waiver does not apply to HMO patients, those patients may still qualify for other options, such as the hospital’s new Choice Pay Plan, which offers a discount of up to 50 percent of the patient’s part of the hospital bill, with a $10,000 limit. The Choice Pay Plan applies to uninsured patients as well as out-of-network insured patients.

Preslar said the hospital is still hopeful that BCBSNC would make a proposal for a new contract with Baptist that would pay fair reimbursement rates. The hospital announced in March that it would terminate its contract with BCBSNC, citing the insurance plan’s refusal for more than a year to negotiate fair rates. The current BCBSNC rates are below the hospital’s costs and even below the Medicaid reimbursement rates.

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Media contacts: Mark Wright, (336) 716-3382,, or Shannon Koontz, (336) 716-2415,

About Wake Forest University Baptist Medical Center: Wake Forest Baptist is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University School of Medicine. It is licensed to operate 1,282 acute care, psychiatric, rehabilitation and long-term care beds and is consistently ranked as one of “America’s Best Hospitals” by U.S. News & World Report.

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