Network P and S Frequently Asked Questions
Last Updated on August 3, 2023
Update: Methodist Le Bonheur health system and BlueCross have reached an agreement, and the health system is in-network for our Blue Network P and S plans effective June 1. Methodist Healthcare and Le Bonheur Children's Hospital facilities returned to our BlueCare Tennessee networks on Feb. 8, 2023. Read the full announcement here.
We are working hard to keep you up to date on the latest information. Below are answers to your most commonly asked questions. This page will be updated frequently, so please check back for more information. Some of the terms we’ve used below may not be familiar. We’ve compiled a glossary of terms to help explain what each of the elements means.
The Situation
Yes. We had hoped Methodist Le Bonheur Healthcare facilities would remain in our networks and are still working to reach a new agreement that will bring them back in network. However, employers and members are always asking us to help lower costs, and the need for affordability became more urgent during the pandemic and as inflation rose. We’re actively negotiating new contracts – or ending contracts – with health systems that are being paid much higher rates than their peers, including the Methodist Le Bonheur Healthcare system. As part of our ongoing efforts to help control the cost of care, we ended our current contract with Methodist Le Bonheur Healthcare and are working to reach new agreements for most of our networks.
Since we were not able to come to an agreement by Dec. 31, 2022, the following Methodist Le Bonheur Healthcare facilities are considered out-of-network as of Jan. 1, 2023, for Network P.
- Methodist University Hospital
- Methodist Healthcare – Germantown
- Methodist Healthcare – North Hospital
- Methodist Healthcare – Olive Branch Hospital
- Methodist Healthcare – South Hospital
- Methodist Blood and Marrow Transplant Center
- Methodist Comprehensive Breast Center – Germantown and Midtown locations
- Methodist Le Bonheur Children’s Hospital
- Methodist Le Bonheur Germantown
- Methodist Le Bonheur Germantown Surgery Center
- Wolf River Surgery Center (effective Oct. 23, 2023)
The following facilities have been removed from Network S:
- Methodist Le Bonheur Children’s Hospital
- Methodist Le Bonheur Germantown
While we hope to come to an agreement that would bring Methodist Le Bonheur Children’s Hospital and Le Bonheur Germantown back to both Network P and Network S, we will be removing the following facilities from Network S permanently:
- Methodist Alliance Home Care Services
- Methodist Alliance Home Medical Equipment
- Methodist Healthcare Minor Medical Center (Cordova, Hacks Cross, Midtown Memphis, Olive Branch)
- Methodist Le Bonheur Germantown Surgery Center
- Wolf River Surgery Center (effective Oct. 23, 2023)
- Methodist Alliance Hospice (effective Oct. 31, 2023)
Please note this does not impact Methodist Le Bonheur-affiliated physician groups, only the facilities listed above.
Our members and employer customers are asking us for help in managing rapidly rising health care costs, and we have a responsibility to deliver.
Methodist Le Bonheur Healthcare system was charging us rates that were significantly higher than our average rates for other facilities in the Memphis area. As it is our mission to provide affordable health care, we continued negotiations with them until we reached an agreement.
We continue to work on an agreement to bring Methodist Le Bonheur Healthcare back in network. However, if you are covered by BlueCross Network P or S through your employer or an independently purchased plan, any care you receive at the following Methodist Le Bonheur facilities on or after Jan. 1, 2023, will be considered out-of-network.
- Methodist University Hospital
- Methodist Healthcare – Germantown
- Methodist Healthcare – North Hospital
- Methodist Healthcare – Olive Branch Hospital
- Methodist Healthcare – South Hospital
- Methodist Blood and Marrow Transplant Center
- Methodist Comprehensive Breast Center – Germantown and Midtown locations
- Methodist Le Bonheur Children’s Hospital
- Methodist Le Bonheur Germantown
- Methodist Le Bonheur Germantown Surgery Center
- Wolf River Surgery Center (effective Oct. 23, 2023)
The following facilities have been removed from Network S:
- Methodist Le Bonheur Children’s Hospital
- Methodist Le Bonheur Germantown
While we hope to come to an agreement that would bring Methodist Le Bonheur Children’s Hospital and Le Bonheur Germantown back to both Network P and Network S, we have removed the following facilities from Network S permanently as of Jan. 1, 2023:
- Methodist Alliance Home Care Services
- Methodist Alliance Home Medical Equipment
- Methodist Healthcare Minor Medical Center (Cordova, Hacks Cross, Midtown Memphis, Olive Branch)
- Methodist Le Bonheur Germantown Surgery Center
- Wolf River Surgery Center (effective Oct. 23, 2023)
- Methodist Alliance Hospice (effective Oct. 31, 2023)
Please note this does not impact Methodist Le Bonheur-affiliated physician groups, only the facilities listed above.
Since a new agreement has not been reached, Methodist Le Bonheur Healthcare facilities are no longer participating in Network P as of Jan. 1, 2023. Impacted facilities include:
- Methodist University Hospital
- Methodist Healthcare – Germantown
- Methodist Healthcare – North Hospital
- Methodist Healthcare – Olive Branch Hospital
- Methodist Healthcare – South Hospital
- Methodist Blood and Marrow Transplant Center
- Methodist Comprehensive Breast Center – Germantown and Midtown locations
- Methodist Le Bonheur Children’s Hospital
- Methodist Le Bonheur Germantown
- Methodist Le Bonheur Germantown Surgery Center
- Wolf River Surgery Center (effective Oct. 23, 2023)
The following facilities have been removed from Network S:
- Methodist Le Bonheur Children’s Hospital
- Methodist Le Bonheur Germantown
While we hope to come to an agreement that would bring Methodist Le Bonheur Children’s Hospital and Le Bonheur Germantown back to both Network P and Network S, we have removed the following facilities from Network S permanently as of Jan. 1, 2023:
- Methodist Alliance Home Care Services
- Methodist Alliance Home Medical Equipment
- Methodist Healthcare Minor Medical Center (Cordova, Hacks Cross, Midtown Memphis, Olive Branch)
- Methodist Le Bonheur Germantown Surgery Center
- Wolf River Surgery Center (effective Oct. 23, 2023)
- Methodist Alliance Hospice (effective Oct. 31, 2023)
From time to time, it becomes necessary for BlueCross to focus our networks so that we can offer our members the best possible pricing and combat the ever-rising cost of health care. Permanently removing these facilities and services from our Network S helps us to lower the cost of coverage for our Memphis-area members.
Network S members will continue to have access to the full range of quality care from other Memphis-area providers and through our preferred partnerships with Baptist Memorial Health Care system, St. Francis Hospital and Regional One Health.
Your Care
Since we couldn't reach an agreement by Dec. 31, 2022, BlueCross members - including those covered by Network P, Network S, BlueCare Tennessee, TennCare Select, CoverKids, and the Dual Special Needs Plan (D-SNP) - will need to seek care from other facilities as of Jan. 1, 2023.
If you are covered by one of our impacted plans, any care you receive at Methodist Le Bonheur facilities on or after Jan. 1, 2023, will be considered out-of-network, and you will likely be required to pay more for the care you receive there.
Members will once again be able to get care at these Methodist Le Bonheur facilities at affordable, in-network rates. Your coverage depends on your network – please refer to the guide below, and if you have any questions, call the telephone number on the back of your Member ID card.
|
Facility or Hospital |
Network Impacted |
|
|
Blue Network P |
Blue Network S |
|
|
Methodist Healthcare University Hospital |
x |
|
|
Methodist Blood and Marrow Transplant Center at Methodist University Hospital |
x |
|
|
Methodist Comprehensive Breast Center (Germantown and Midtown locations) |
x |
|
|
Methodist Healthcare North Hospital |
x |
|
|
Methodist Healthcare South Hospital |
x |
|
|
Methodist Healthcare Olive Branch |
x |
|
|
Methodist Healthcare Germantown |
x |
|
|
Methodist Surgery Center – Germantown |
x |
|
|
Le Bonheur Children’s Medical Center |
x |
x |
|
Le Bonheur Children’s Medical Center – Germantown |
x |
x |
We have removed the following facilities from Network S permanently as of Jan. 1, 2023:
- Methodist Alliance Home Care Services
- Methodist Alliance Home Medical Equipment
- Methodist Healthcare Minor Medical Center (Cordova, Hacks Cross, Midtown Memphis, Olive Branch)
- Methodist Le Bonheur Germantown Surgery Center
- Wolf River Surgery Center (effective Oct. 23, 2023)
- Methodist Alliance Hospice (effective Oct. 31, 2023)
Please note this does not impact Methodist Le Bonheur-affiliated physician groups, only the facilities listed above.
We are committed to coordinating care for our members and helping them get the services they need. We maintain an excellent network of hospitals and surgery centers where you and your family can receive care. Your BlueCross plan gives you the freedom to visit the health care facility of your choice. Members can call the number on the back of their Member ID or visit bcbst.com for help finding alternative care options.
However, since we were unable to reach an agreement, if you use a Methodist Le Bonheur Healthcare facility on or after Jan. 1, 2023, you will receive out-of-network benefits, which means you will pay more for the same care that you could receive from an in-network facility.
Yes, you should always go to the closest hospital of your choice. Emergency room benefits for true emergencies have not been affected even though Methodist Le Bonheur Healthcare has left our network. Covered emergency room benefits for true emergencies are covered as in-network. Please note that, if admitted and once stabilized, you will need to be transferred to a participating facility. See below for the definition of a true emergency.
An emergency is defined as a sudden and unexpected medical condition that manifests itself by symptoms of sufficient severity, including severe pain, that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect to result in:
- serious impairment of bodily functions; or
- serious dysfunction of any bodily organ or part; or
- placing a prudent layperson’s health in serious jeopardy.
- Examples of emergency conditions include: (1) severe chest pain; (2) uncontrollable bleeding; or (3) unconsciousness.
Doctors and Health Facilities
This does not impact providers who are part of Methodist Le Bonheur-affiliated physician groups, only the facilities. If you get your BlueCross health plan through work or if you’re under 65 and purchase your or your family’s coverage on or off the Health Insurance Marketplace, then any care you receive from Methodist Le Bonheur-affiliated facilities is considered out-of-network after Dec. 31, 2022. This means you will likely be required to pay more for the care you receive on or after Jan. 1, 2023.
We urge you to use our member directory to see if your caregiver is in-network.
Since an agreement was not reached, Methodist Le Bonheur Healthcare facilities have been removed from several BlueCross networks, including Network P, BlueCare Tennessee, TennCare Select, CoverKids and the Dual Special Needs Plan (D-SNP) as of Jan. 1, 2023. Impacted facilities include:
- Methodist University Hospital
- Methodist Healthcare – Germantown
- Methodist Healthcare – North Hospital
- Methodist Healthcare – Olive Branch Hospital
- Methodist Healthcare – South Hospital
- Methodist Blood and Marrow Transplant Center
- Methodist Comprehensive Breast Center – Germantown and Midtown locations
- Methodist Le Bonheur Children’s Hospital
- Methodist Le Bonheur Germantown
- Methodist Le Bonheur Germantown Surgery Center
- Wolf River Surgery Center (effective Oct. 23, 2023)
The following facilities have been removed from Network S:
- Methodist Le Bonheur Children’s Hospital
- Methodist Le Bonheur Germantown
While we hope to come to an agreement that would bring Methodist Le Bonheur Children’s Hospital and Le Bonheur Germantown back to both Network P and Network S, we have removed the following facilities from Network S permanently as of Jan. 1, 2023:
- Methodist Alliance Home Care Services
- Methodist Alliance Home Medical Equipment
- Methodist Healthcare Minor Medical Center (Cordova, Hacks Cross, Midtown Memphis, Olive Branch)
- Methodist Le Bonheur Germantown Surgery Center
- Wolf River Surgery Center (effective Oct. 23, 2023)
- Methodist Alliance Hospice (effective Oct. 31, 2023)
Please note this does not impact Methodist Le Bonheur-affiliated physician groups, only the facilities listed above.
Methodist Le Bonheur Healthcare physician groups are not impacted by this change and will remain in BlueCross networks.
As of Jan. 1, 2023, your care will be considered out-of-network if you deliver at one of Methodist Le Bonheur’s facilities.
Your BlueCross plan gives you the freedom to visit the hospital of your choice. However, since we were not able to reach an agreement, if you use a Methodist Le Bonheur Healthcare facility on or after Jan. 1, 2023, you will receive out-of-network benefits, which means you will pay more for the same care that you could receive from an in-network facility.
Our goal is to ensure you experience minimal disruptions in care. If you still have delivery scheduled at a Methodist Le Bonheur Healthcare facility, a nurse from BlueCross BlueShield of Tennessee can help you understand your in-network options and help make sure you continue to receive appropriate care. Call the Member Service number on the back of your Member ID for personal assistance.
Scheduled Procedures/Ongoing Treatment
As of Jan. 1, 2023, any procedures that you undergo at a Methodist Le Bonheur Healthcare facility will be considered out-of-network.
Your BlueCross plan gives you the freedom to visit the hospital of your choice. However, since we were not able to reach an agreement, if you use a Methodist Le Bonheur Healthcare facility on or after Jan. 1, 2023, you will receive out-of-network benefits, which means you will pay more for the same care that you could receive from an in-network facility.
Under our Continuity of Care policy, some Methodist Le Bonheur Healthcare patients may be granted in-network status. Patients who may qualify for this status include:
- Patients whose practitioner/facility are terminated from the network during treatment, i.e., chemotherapy or radiation patients; and
- Patients with complex medical and/or behavioral health conditions.
If you think you qualify for in-network status, please call our Member Service line at 1-800-565-9140 or complete this form and return it to: BlueCross BlueShield of Tennessee, 1 Cameron Hill Circle, Ste. 0002, Chattanooga, TN 37402-0002.
Since we did not reach an agreement by the Dec. 31, 2022, deadline, we want to make you aware of a few options you will have when it comes to your care.
If you have ongoing services scheduled at a Methodist Le Bonheur Healthcare facility, a nurse from BlueCross can work with you and help make sure you continue to receive appropriate care at an in-network health care provider. You can also search for a new provider using the Find Care tool on BCBST.com or call the Member Service number on the back of your Member ID for personal assistance. Our goal is to ensure you experience no disruptions in care.
Under our Continuity of Care policy, some Methodist Le Bonheur Healthcare patients may be granted in-network status. Patients who may qualify for this status include:
- Patients whose practitioner/facility are terminated from the network during treatment, i.e., chemotherapy or radiation patients; and
- Patients with complex medical and/or behavioral health conditions.
If you think you qualify for in-network status, please call our Member Service line at 1-800-565-9140 or complete this form and return it to: BlueCross BlueShield of Tennessee, 1 Cameron Hill Circle, Ste. 0002, Chattanooga, TN 37402-0002.