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Frequently Asked Questions (FAQs)

EagleMed leaving network effective Jan. 1, 2017

We are disappointed to announce that officials with Med-Trans – operating in Kansas as EagleMed – have decided to not be a contracting provider in the Blue Cross and Blue Shield of Kansas/BlueCross BlueShield Kansas Solutions network effective Jan. 1, 2017.

Our provider network includes several ambulance companies that provide ground transportation and two other air ambulance companies, including LifeStar of Kansas and LifeTeam. Beginning Jan. 1, 2017, AMR Air Ambulance will be joining our network to provide additional coverage throughout our service area.

We recognize that our members often don't have a say in the air ambulance company that responds to them in an emergency situation. In the event of an emergency, we always want our members to get to the nearest or most appropriate hospital as quickly as possible. As such, we assure that our maximum allowance for contracting and non-contracting providers in an emergency is the same, and we will waive any penalties for using a non-contracting provider in an emergency. Our BlueCross BlueShield Kansas Solutions members will have benefits for transportation in an emergency even if a non-contracting air ambulance provider is involved.

If you receive non-emergency transportation from EagleMed on or after Jan. 1, 2017, your out-of-pocket expenses will increase and you will be responsible for directly paying EagleMed. Beginning Jan. 1, 2017, EagleMed may bill our members for the difference between our allowance and their actual charge. In addition, in non-emergency situations our allowance to a non-contracting provider is 20 percent less than our allowance for a like contracting provider for the same service, and EagleMed can bill you for this difference, too. Additional out-of-network penalties may apply. Also, we will reimburse our member for covered services who then, in turn, is responsible for paying EagleMed.

BlueCross BlueShield Kansas Solutions members who are transported by EagleMed in a non-emergency situation will not have benefits as EagleMed will be a non-contracting provider.

EagleMed provides an important service for our members when getting to an emergency room quickly is of critical importance or when transportation to another hospital is key for receiving treatment. We hope Med-Trans will reconsider their position and in doing so, we will welcome them back into our network in the future.

FAQs

I have Plan 65 Medicare supplement insurance; how does this change affect me?
This change in the contracting status of EagleMed does not affect our members who have Plan 65 or Plan 65-Select Medicare supplement insurance. As long as the transportation is deemed medically necessary by Medicare and EagleMed meets Medicare's requirements as a provider, then covered services are paid accordingly, first by Medicare and second by Plan 65.
When is this change effective?
It is effective Jan. 1, 2017. Until then, EagleMed remains a BCBSKS and Solutions contracting provider and will accept our allowance as payment in full; EagleMed will not bill members for the balance for services received through Dec. 31, 2016.
What other air ambulance companies are available to BCBSKS members?
Our provider network includes two other air ambulance companies – LifeStar of Kansas and LifeTeam – that will be able to provide services to our members throughout our service area. Beginning Jan. 1, 2017, AMR Air Ambulance will be joining our network to provide additional coverage throughout our service area. We will continue to look at other opportunities to add other air ambulance companies to our network.
What happens if I have been severely injured in a rural part of our state and an emergency responder calls for an air ambulance and EagleMed responds?
We recognize that our members often don't have a say in the air ambulance company that responds to them in an emergency situation. The call is usually made by emergency management officers or hospital staff. In the event of a true emergency, we always want our members to get to the nearest or most appropriate hospital as quickly as possible. As such, we assure that our maximum allowance for contracting and non-contracting providers in an emergency is the same, and we will waive any penalties for using a non-contracting provider in an emergency. Our BlueCross BlueShield Kansas Solutions members will have benefits for transportation in an emergency even if a non-contracting air ambulance provider is involved. It is important to note, though, that EagleMed could still bill our members for the difference between our allowance and their actual charge.
What if you are already in a hospital and you need to be transferred to another hospital for care?
We are educating our hospital partners regarding which air ambulance companies are contracting with Blue Cross and Blue Shield of Kansas and BlueCross BlueShield Kansas Solutions, and which are not. This way, when transportation is needed from one hospital to another, they will know to call a contracting provider for our members. However, when transportation is required due to an emergency, our maximum allowance for contracting and non-contracting providers is the same, and we will waive any penalties for using a non-contracting provider in an emergency. Our BlueCross BlueShield Kansas Solutions members will have benefits for transportation in an emergency even if a non-contracting air ambulance provider is involved. It is important to note, though, that EagleMed could still bill our members for the difference between our allowance and their actual charge.
If I am transported by EagleMed after Jan. 1, what else do I need to know?
First of all, our payment will be sent directly to the member, who is then responsible for paying the non-contracting provider. Second, whenever a BCBSKS member receives covered services from a non-contracting provider, the provider can bill the member for the difference between our maximum allowable payment and his or her charges.
I am a BlueCross BlueShield Kansas Solutions member. What if I am transported by EagleMed in a non-emergency situation?
If you receive non-emergency services from a non-contracting provider, you have no benefits and would be responsible for paying the entire amount charged by EagleMed.
Why does Blue Cross and Blue Shield of Kansas contract with providers? Why not let members use any provider they choose?
We contract with providers as a way to control the cost of health insurance premiums for our members, and because we have a responsibility to our members to be good stewards of their hard-earned dollars. This means taking the steps necessary to assure that they have access to quality health care while keeping premiums as low as possible. We believe in reimbursing health care providers fairly, but we must sometimes draw the line with providers to protect our members from increased costs.

When we contract with providers, they agree to accept our maximum allowable payment (MAP) for the covered services they provide our members; further, they agree to accept our allowance as "payment-in-full" and not bill our members for the balance between our allowance and their charge. In 2015, these contracts with providers saved our members more than $2.5 billion. Without these savings, premiums would have nearly doubled when you consider that we paid out nearly the same amount in claims during 2015.

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