Hospital-based clinic update for BCBSNC members

Beginning Aug. 1, seventeen UNC clinics will no longer be categorized as “hospital-based” for most with Blue Cross and Blue Shield of North Carolina (BCBSNC). UNC Health Care and BCBSNC have collaborated to make routine visits and services at newly designated independent UNC clinics more affordable and easier to access for BCBSNC members.

Hospital-based clinic update for BCBSNC members click to enlarge Click on the image for a sample of a patient's out-of-pocket (OOP) cost at UNC's newly independent clinics.

Effective Aug. 1, services received at these independent UNC clinics will be treated as an office visit, with the patient’s estimated out-of-pocket payment equal to the amount of the copay, which will be due at the time of service.  

This applies to BCBSNC members (including UNC Health Care Employees, others using the State Health Plan, Federal Employee Program, and members of other select Blue Cross and Blue Shield Plans) who are enrolled in plans that include copayments for primary care and specialist office visits.

Click on the image at right to see a sample of a patient's out-of-pocket (OOP) cost at UNC's newly independent clinics.

UNC Hospitals Independent Clinics as of Aug. 1

  • Urology Clinic—NC Memorial Hospital
  • Endovascular Clinic—NC Memorial Hospital
  • Endovascular Clinic—Meadowmont
  • Heart Center—Meadowmont
  • Gastroenterology Clinic—NC Memorial Hospital
  • Gastroenterology Clinic—Meadowmont
  • GI Procedures—Meadowmont*
  • Pediatric Specialty Clinic—NC Children’s Hospital
  • N.C. Children’s Specialty Clinic—Rex Hospital Campus
  • Rheumatology/Allergy Clinic—Carolina Pointe II
  • Nephrology Clinic—Ambulatory Care Center (ACC)
  • Pulmonary Clinic—Ambulatory Care Center (ACC)
  • Pain Clinic—Southern Village
  • Geriatrics Clinic—Carolina Pointe II
  • Spine Clinic—Center at Hwy 54
  • Wound Clinic—NC Memorial Hospital
  • Diabetes Endocrine Clinic—Highgate

*GI Procedures at NC Memorial Hospital is not a designated independent clinic and subject to patients’ plan’s deductible and coinsurance amounts.

Some clinics still 'hospital-based'

Some UNC clinics will still be categorized as “hospital-based.” Please know that more specialized care and services received at UNC’s hospital-based clinics, such as cancer or transplant services, will still be subject to deductible and coinsurance amounts, if applicable.

Also, if patients receive services at more than one UNC clinic on the same day, each clinic visit will be treated separately and will be subject to any applicable estimated out-of-pocket payment such as the copayment, deductible and/or coinsurance amounts.

UNC and BCBSNC are mutually committed to improving the service that we provide to our patients, and this change is in direct response to the feedback we have received from our patients and BCBSNC members.

If you have any questions, please contact UNC HealthLink at 966-7890.

Which UNC clinics ARE NOT being reclassified as independent clinics and why?

UNC specialty clinics focused on oncology/cancer care and transplant services, as well as diagnostic and treatment areas (MRI, CT scans, etc.), are excluded from this designation due to the complex nature of the care and services provided. Billing practices for all UNC clinics and treatment areas not listed above (Independent Clinics as of Aug. 1) will remain the same.

What is a hospital-based clinic?

Under Medicare rules, a physician’s office can meet specified operating criteria to become “hospital-based” clinics.  They may be located either physically on-site at the hospital or as a freestanding facility.  Many specialty services are only available under a hospital-based operating structure.  As a result of this higher level of specialized care, hospital-based clinics may result in higher out-of-pocket expenses for patients than a private physician’s office.

Will there be a change to BCBSNC member benefits?

No, there is no change to member benefits. BCBSNC and UNC Hospitals have renegotiated portions of their contract to reclassify select hospital-based clinics as “independent” clinics within our participating provider network. This reclassification will enhance the affordability and ease of using select UNC clinics for routine care, as BCBSNC members will only have to pay a copayment for services received at these independent clinics.

If you have any other questions, please contact UNC HealthLink at 966-7890.

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