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

July 14, 2005

WINSTON-SALEM, N.C. – North Carolina Baptist Hospital has extended indefinitely its waiver of all financial “penalties” for patients who have Blue Cross and Blue Shield of North Carolina (BCBSNC) out-of-network benefits.

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

The waiver was originally to run for 90 days after the hospital’s contract with the insurance plan terminated on June 4. Len B. Preslar Jr., the hospital’s president and CEO, said the waiver has benefited many patients and should be extended. “Blue Cross patients want to continue to be able to use their out-of-network benefits to come to Baptist Hospital, and this will allow them to do that without worrying about increased out-of-pocket expenses.”

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.

The hospital has not seen a substantial decrease in BCBSNC patients since the contract terminated.

Many BCBSNC members do not need the out-of-network waiver because they 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.

Baptist is currently in discussion with BCBSNC to determine the potential for a new agreement.

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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 1,187 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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