Questions and answers regarding Anthem coverage at St. Francis Hospital & Health Centers:
Why is St. Francis ending its contract with Anthem?
St. Francis has sent a notice of termination to Anthem that is effective Nov. 2, 2008. The reason for the termination is due to serious claims issues with Anthem that have not been resolved over the past year.
Is St. Francis in negotiations with Anthem?
[updated 10/23/08] No meetings are planned at this time. It is our hope that a resolution will be reached.
Which Anthem plans are affected by this?
The affected plans include:
- Anthem Blue Access PPO
- Anthem Blue Preferred HMO
- Anthem Traditional
- Anthem Medicare Advantage PPO
- Anthem Healthy Indiana Plan (HIP)
What if I have another Blue Cross and Blue Shield plan? Am I affected?
Members of any Blue Cross and Blue Shield plan nationwide who come to Indiana hospitals (including St. Francis) are accessing a contract only through Anthem. Without an Anthem contract, all BCBS plans will be accessing St. Francis out-of-network.
St. Francis is working to develop options so that Anthem patients are not adversely affected by out-of-pocket costs through the rest of 2008.
If I have Anthem insurance, what does this mean for my health care choices?
If you have Anthem insurance, you can continue to receive care at St. Francis as an in-network patient until Nov. 2, 2008. Recent correspondence from Anthem to its patients suggests that Anthem will continue to process St. Francis claims for an additional 30-day period at in-network benefit levels, but we currently are learning more about this. We suggest that Anthem patients call Anthem to learn more about this advice.
St. Francis is working to develop options so that Anthem patients are not adversely affected by out-of-pocket costs through the rest of 2008.
As always, you should follow your insurance plan’s pre-certification requirements.
Could Anthem stop me from coming to St. Francis?
Anthem’s insurance benefit plans allow patients to use Anthem’s out-of-network benefits If for any reason and at any time your request for services at St. Francis is being denied by Anthem, you should voice your protest to Anthem and your employer.
As always, you should follow your insurance plan’s pre-certification requirements.
What if I have an emergency? Can I still come to St. Francis for emergency services?
Medically necessary emergency services are not subject to the in-network or out-of-network rules of a health plan and will not be impacted by any termination.
I am currently in the middle of treatment. What happens to my care?
Most of Anthem’s benefit plans have an out-of-network benefit available, allowing you to use non-contracted providers. Benefit plans also have continuation of services benefits that allow patients currently in treatment for a condition to continue receiving some services at a terminated provider.
Call your benefits administrator or Anthem about continuation of care benefits provided in your benefit plan.
St. Francis is working to develop options so that Anthem patients are not adversely affected by out-of-pocket costs through the rest of 2008.
As always, you should follow your insurance plan’s pre-certification requirements.
I am currently pregnant. What happens to my care?
Most of Anthem’s benefit plans have an out-of-network benefit available, allowing you to use non-contracted providers. Benefit plans also have continuation of services benefits that allow patients currently in treatment for a condition (including pregnancy) to continue receiving some services at a terminated provider.
Call your benefits administrator or Anthem about continuation of care benefits provided in your benefit plan.
St. Francis is working to develop options so that Anthem patients are not adversely affected by out-of-pocket costs through the rest of 2008.
As always, you should follow your insurance plan’s pre-certification requirements.
Will patients be able to get in-network levels of benefits for other services at St. Francis after Nov. 2, when the contract ends?
Most of Anthem’s benefit plans have an out-of-network benefit available allowing you to use non-contracted providers. Benefit plans also have continuation of services benefits that allow patients currently in treatment for a condition to continue receiving some services at a terminated provider.
Patients who are currently seeking services at St. Francis, such as for pregnancy and serious medical conditions, should call their benefits administrator or Anthem about continuation of care benefits provided in their benefit plans.
St. Francis is working to develop options so that Anthem patients are not adversely affected by out-of-pocket costs through the rest of 2008.
As always, you should follow your insurance plan’s pre-certification requirements.
If the St. Francis termination with Anthem goes into effect in November, what does this mean for my bill? Will Anthem send payments to St. Francis or directly to me?
It is likely that payments from Anthem will be sent directly to the patient’s home address. Payment ultimately is the patient’s responsibility, and any money paid directly to you should be forwarded immediately to satisfy your bills with St. Francis.
Who can Anthem participants in Indianapolis contact for more information?
Staff at St. Francis is available to answer many of the questions you may have during this unfortunate development. Patients, as always, are welcome to call us directly, send an e-mail or call a dedicated hotline for concerns specific to Anthem.
Specific questions about benefits and claims should be addressed to your plan’s benefit administrator (Anthem).
