BusinessReport.com

Editors note: Information obtained from Blue Cross Blue Shield.

1/21/08

1. When does the contract between Blue Cross and the FMOL Health System expire?

The contract between Blue Cross and the FMOL Health System expires as of January 31, 2008. It also affects our HMO Louisiana network as well as the AccessCare PPO network, used by Benefit Management Services customers.

2. Is there a transition period for customers to allow time to finish their treatment with FMOL hospitals or providers and make new arrangements?

We are allowing a transition period to give members time to complete their treatment with the FMOL hospital system and affiliated providers. The transition period varies by product line.

1. FOR PPO and TRADITIONAL CUSTOMERS:

a. To make this transition as easy as possible for our customers, we have given them time to change to another hospital within the Blue Cross network. This transition is from Feb. 1, 2008, through April 30, 2008. During this time the following changes will apply.

i. Blue Cross will waive the 30 percent penalty imposed for non-network services when you use an FMOL hospital. Your policy says that when you use a hospital that is not in one of our networks, your benefits will be reduced by 30 percent. But during this transition period, we will waive this penalty when you use an FMOL hospital. In the case of an emergency, you should go to the nearest hospital for care and the 30 percent penalty will not apply.

ii. During this period, please be aware that you may be subject to balance billing by the hospital. Balance billing is the difference between the hospital’s billed charges and the amount Blue Cross has allowed for the service you receive. However, Blue Cross will continue to pay our in-network allowable fee schedule to help reduce your out-of-pocket costs. If you have a PPO product, you will have to pay out-of-network coinsurance, which is usually higher than in-network coinsurance. If you have a traditional product, your coinsurance will stay the same, but you are still subject to balance billing.

2. FOR PREMIER BLUE CUSTOMERS

a. To make this transition as easy as possible for our customers, we have given them time to change to another hospital within the Blue Cross network. This transition is from Feb. 1, 2008, through April 30, 2008. During this time the following changes will apply.

i. Blue Cross will waive the 30 percent penalty imposed for non-network services when you use an FMOL hospital. Your policy says that when you use a hospital that is not in one of our networks, your benefits will be reduced by 30 percent. But during this transition period, we will waive this penalty when you use an FMOL hospital. In the case of an emergency, you should go to the nearest hospital for care and the 30 percent penalty will not apply.

ii. During this period, you will be switching from your usual in-network copayments to the non-network coinsurance and deductibles specified in your plan documents when you use a non-network provider.

iii. Please be aware that you may be subject to balance billing by the hospital. Balance billing is the difference between the hospital’s billed charge and the amount Blue Cross has allowed for the service you receive. However, Blue Cross will pay the FMOL providers based on our highest allowable fee schedule to reduce your out-of-pocket costs.

3. FOR POS/ADVANTAGE BLUE CUSTOMERS

a. To make this transition as easy as possible for our customers, we have given them time to change to another hospital within the Blue Cross network. This transition is from Feb. 1, 2008, through April 30, 2008. During this time the following changes will apply.

i. You will be switching from your usual in-network copayments to the non-network deductible and coinsurance specified in your plan documents when you use a non-network provider.

ii. Please be aware that you may be subject to balance billing by the hospital. Balance billing is the difference between the hospital’s billed charge and the amount Blue Cross has allowed for the service you receive. However, Blue Cross will pay the FMOL providers based on our highest allowable fee schedule to reduce your out-of-pocket costs.

4. FOR HMO/HMO CUSTOMERS

a. To make this transition as easy as possible for our customers, we are allowing a transition period, which will last until March 15. This will give our customers time to change to another hospital and doctor within the HMO network.

i. During this transition you will pay your usual, in-network copayment when you use an FMOL provider. We encourage you to call to get authorizations for any procedures you may need. Please remember, after the transition period, according to your policy you must use in-network providers to receive benefits. Please see your policy for more information.

3. Can you explain why a provider might charge me an additional balance? I’ve been told that during the transition time an FMOL hospital may “balance bill” me. Why?

All of the providers in our networks agree not to bill the patient for the difference between the hospital’s billed charge and the amount we have allowed for the service you receive. They also agree to file claims on behalf of patients, and to accept our allowable charge - plus any applicable deductible, copayment or coinsurance - as payment in full for covered services. Providers that are not in our network can make the patient pay the balance above our allowable charge.

However, Blue Cross will pay the FMOL providers based on our highest allowable fee schedule to reduce your out-of-pocket costs.

4. What happens after the transition period?

All non-network benefits will apply. As a reminder, if you have an HMO product, you have no benefits if you see an out-of-network doctor or hospital.

5. My mom is currently being treated in an FMOL hospital. What happens to her?

If a Blue Cross customer is already in an FMOL hospital, he or she will continue to receive in-network benefits, until he or she leaves the hospital. Members who were inpatient on January 31, 2008, and remain inpatient on or after February 1, 2008, will not be subject to balance billing.

6. I am happy with my current healthcare provider in the FMOL system. May I still use this provider?

Customers will always have the option to use FMOL hospitals or FMOL healthcare providers, but if they do, non-network benefits will apply. These costs are outlined in your policy.

7. Why will the FMOL system no longer be included in my network?

The FMOL Health System has chosen not to renew its contract with Blue Cross and Blue Shield of Louisiana because it did not receive the double-digit pay increase it requested from us. Blue Cross already reimburses hospitals in the FMOL system at a much higher level than other hospitals in their markets (and are paid significantly more than the majority of the hospitals in the state). We are committed to our mission of providing health guidance and affordable access to quality care; if we were to pay FMOL at higher rates, it would ultimately cost our customers more.

8. What are the affected hospitals and where are they located?

Hospitals in the FMOL system include:

• Assumption Community Hospital, Napoleonville

• St. Elizabeth Hospital, Gonzales

• St. Francis Medical Center, Monroe

• St. Francis North Hospital, Monroe

• Our Lady of the Lake Regional Medical Center, Baton Rouge

• Our Lady of Lourdes Regional Medical Center, Lafayette

• Tau Center for Chemical Dependency, Baton Rouge

9. What are my options for network hospitals in the Baton Rouge area?

A complete list of network hospitals may be found on the Blue Cross website. Some of the main facilities in the area include:

• Baton Rouge General Medical Center (Baton Rouge)

• Baton Rouge Surgical Hospital (Baton Rouge)

• Lane Regional Medical Center (Zachary)

• Neuromedical Center (Baton Rouge)

• North Oaks (Hammond)

• Ochsner Medical Center (Baton Rouge)

• Surgical Specialty Center (Baton Rouge)

• Woman’s Hospital (Baton Rouge)

This list does not apply to BlueChoice 65 Select customers

10. What are my options for network hospitals in the Lafayette area?

A complete list of network hospitals may be found on the Blue Cross website. Some of the main facilities in the area include:

• Doctors Hospital of Opelousas (Opelousas)

• Heart Hospital of Lafayette (Lafayette)

• Lafayette General Medical Center (Lafayette)

• Opelousas General Medical Center (Opelousas)

• Park Place (Lafayette)

• Southwest Medical Center (Lafayette)

• Women’s and Children’s (Lafayette)

This list does not apply to BlueChoice 65 Select customers

11. What are my options for network hospitals in the Monroe area?

A complete list of network hospitals may be found on the Blue Cross website. Some of the main facilities in the area include:

• Glenwood Regional Medical Center (Monroe)

• Green Clinic Hospital (Ruston)

• Monroe Surgical Hospital (Monroe)

• Ouachita Surgical Hospital (Monroe)

This list does not apply to BlueChoice 65 Select customers

12. What happens if my doctor only has admitting privileges to a FMOL hospital?

One of the conditions of network participation is that physicians have admitting privileges to a participating, member hospital. Physicians who do not have admitting privileges are ineligible to participate in the Blue Cross and HMO Louisiana networks. Therefore, we will have to terminate a limited number of physician contracts. While these contracts typically require a 60-day termination notice, we will provide a 90-day termination notice. One option is for your physician to get admitting privileges at an in-network hospital in your area. In the case of emergency, you can always go to the nearest hospital without penalty.

13. Blue Cross is a healthy company, why won’t it pay the reimbursement rates requested by FMOL?

Blue Cross and Blue Shield of Louisiana is committed to its mission of providing health guidance and affordable access to quality care. Blue Cross has a responsibility to serve as advocates for our customers and to hold down healthcare costs. We are concerned with both the physical AND financial health of our customers. . . and to pay higher reimbursement fees to FMOL hospitals would mean HIGHER premiums for customers.

14. How do I find out if my preferred doctor is in my network?

We recommend you contact your healthcare provider directly to see if he or she is included in the network. You also may check the searchable provider directories on our website at www.bcbsla.com or call the Customer Service telephone number listed on your ID card.

15. My dad has a BlueChoice 65 Select Plan and currently uses an FMOL hospital. What hospital should he use for his healthcare needs?

Blue Cross is allowing a transition period to allow members time to complete their care with the FMOL hospital system and affiliated providers. So if your dad prefers to use an FMOL hospital during the transition period (Feb. 1, 2008 – April 30, 2008), he may. After that period, he should use a BlueChoice 65 Select hospital.

Of course in an emergency situation, your dad should seek treatment at the nearest facility, regardless of the network it is in. Here is a list of participating BlueChoice 65 Select hospitals:

Abbeville General Hospital, Abbeville

Acadia St. Landry Hospital, Church Point

Acadian Medical Center, Eunice

Allen Parish Hospital, Kinder

American Legion Hospital, Crowley

Bunkie General Hospital, Bunkie

Christus St. Frances Cabrini Hospital, Alexandria

Desoto Regional Health System, Mansfield

Doctors’ Hospital, Shreveport

East Jefferson General Hospital, Metairie

Franklin Foundation Hospital, Franklin

Glenwood Regional Medical Center, West Monroe

Iberia Medical Center, New Iberia

Jennings American Legion Hospital, Jennings

Lady of the Sea General Hospital, Cut Off

Lafayette General Medical Center, Lafayette

Lafayette General Surgical Hospital, Lafayette

Lake Charles Memorial Hospital, Lake Charles

Morehouse General Hospital, Bastrop

North Caddo Memorial Hospital, Vivian

Opelousas General Health System, Opelousas

Pointe Coupee General Hospital, New Roads

River Parishes Hospital, LaPlace

River West Medical Center, Plaquemine

Riverside Medical Center, Franklinton

Slidell Memorial Hospital, Slidell

Springhill Medical Center, Springhill

St. James Parish Hospital, Lutcher

St. Martin Hospital, Breaux Bridge

St. Tammany Parish Hospital, Covington

Terrebonne General Medical Center, Houma

Thibodaux Regional Medical Center, Thibodaux

Touro Infirmary, New Orleans

West Jefferson Medical Center, Marrero

Willis Knighton Bossier Health Center, Bossier City

Willis Knighton Medical Center, Shreveport

Willis Knighton Pierremont Health Center, Shreveport

Willis Knighton South, Shreveport

16. What if I need emergency care?

In an emergency situation, you should seek treatment at the nearest facility, regardless of the network it is in.

17. My doctor is treating me for a life-threatening disease. What provisions has Blue Cross made to ensure continuity of care?

If you are receiving care for special circumstances on or before Jan. 31, 2008, such as a high-risk pregnancy, a pregnancy past the 24th week, or if you have a life-threatening illness and are undergoing a course of treatment (for example, diagnosis of cancer), you may be eligible for a Continuity of Care waiver. If you believe you are a candidate, please complete the Continuity of Care Waivers with your doctor. These forms may be found on the Blue Cross website at www.bcbsla.com.

18. Will Mary Bird Perkins or Lake After Hours still be in your networks?

At this time, the Mary Bird Perkins Cancer Center and the Lake After Hours Clinics are still in our networks.

19. I’m getting checks in the mail from Blue Cross when I never got them before. What is this about?

Because your FMOL doctor is not in our networks, we will begin paying you for benefits owed on covered services.