Beginning Nov. 1, 2017, Tanner Health System will no longer participate in the Amerigroup health plan.
Over the past year, Tanner has attempted to negotiate a new contract with Amerigroup. After repeated attempts, it was determined that Tanner and Amerigroup would be unable to come to an agreement. While we do not anticipate a resolution to our concerns, Tanner will continue efforts to engage with Amerigroup about a new contract.
There are generally four subgroups of patients who use the Amerigroup health plan:
- Georgia Families Medicaid
- Georgia Families PeachCare for Kids
- Planning for Healthy Babies
- Georgia Families 360
Of those four groups, only Georgia Families 360 are locked into the Amerigroup network; the others may select another health plan during open enrollment. The Georgia Families 360 subgroup is comprised mostly of children in foster care, adoption assistance programs or in the custody of the juvenile justice system.
This change impacts Amerigroup members using Tanner Health System facilities and Tanner Medical Group practices.
Tanner has reached out by mail to patients on the Amerigroup plan, as well as to area medical providers — both community-based providers and those employed by the health system — to provide information on the upcoming changes and encourage patients to locate an in-network provider to avoid a disruption in their care.
What should patients with an Amerigroup health plan do now?
Patients currently enrolled in the Amerigroup plan should take this opportunity to contact Amerigroup at 1.800.600.4441 and identify another in-network provider to continue receiving care without disruption. Once they have identified a new provider, patients may contact the Tanner providers or facilities they use to arrange for your medical records to be forwarded to the provider. Alternatively, patients may collect their records in person at the Tanner facility or practice that they use. Patients are asked to call ahead to have their records ready when they arrive.
Does this mean Tanner is no longer accepting Medicaid?
No. Tanner will continue to participate in Medicaid. Amerigroup has a contract with the Georgia Department of Community Health to offer coverage to certain Georgia Medicaid beneficiaries. Amerigroup is one of four companies with state contracts to offer these services, and leaving the Amerigroup network does not mean that Tanner is withdrawing from Medicaid. Georgia residents may select another health plan during open enrollment of which Tanner is in-network.
What if a patient wants to continue using Tanner’s services?
Most plans offer an annual open enrollment period during which patients can select another health plan. This is an opportunity for individuals to switch to a plan with which Tanner participates. Note that some patients are automatically enrolled in the Amerigroup plan and do not have the option to change plans, including many in foster care, adoption assistance programs or those in the state juvenile justice system.
A patient is pregnant and expects to deliver at a Tanner hospital. What should she do?
Women who are pregnant and currently seeing a Tanner Medical Group obstetrics provider (including Tanner Healthcare for Women, West Georgia Healthcare for Women or West Georgia OB/GYN) may continue to receive prenatal care from their current providers, deliver at a Tanner facility and receive postpartum care for up to six weeks.
A patient has a chronic or terminal illness and receives care from Tanner. What should he or she do?
Patients receiving care from Tanner for a chronic or terminal illness may continue to receive care from Tanner through Dec. 30, 2017 — 60 days from the date of termination between Tanner and Amerigroup. These patients should use this extended time to contact Amerigroup and find an in-network provider who can continue their care.
What if a patient has a medical emergency?
Anyone experiencing a medical emergency and in need of immediate care should visit the nearest hospital emergency department. For patients enrolled in the Amerigroup plan who use a Tanner Health System emergency department, Tanner will evaluate their condition to determine if they are indeed having a medical emergency and provide treatment until their condition is stable. Tanner will contact Amerigroup on a case-by-case basis to seek authorization for continued services. If authorization is not allowed, Tanner will work with Amerigroup to help arrange transfer to an in-network provider.
What should patients do if they have a procedure scheduled at Tanner after Nov. 1?
Beginning Nov. 1, Tanner will be out-of-network on the Amerigroup plan. Outpatient services — such as surgery, treatment (i.e., radiotherapy, infusion services, etc.) screenings (i.e., colonoscopy, sleep study, etc.) and diagnostic imaging (i.e., MRI, CT, mammography, etc.) would have to be authorized as medically necessary and approved to be rendered by an out-of-network provider. If the service is not approved by Amerigroup to be rendered at Tanner, then the service would need to be rescheduled at an Amerigroup network provider. Patients should contact Amerigroup now to determine if their scheduled procedures are approved on an out-of-network basis or if they should reschedule with another in-network provider.
Who can patients contact if they have questions or concerns?
Patients are encouraged to contact Amerigroup if they have any further questions or concerns. Tanner is glad to work with Amerigroup on single case agreements (SCAs) on an individual basis to avoid hardships or significant disruptions in care. Patients may contact Amerigroup at 1.800.600.4441.