St. Francis, Anthem contract ensures continuum of care for patients

INDIANAPOLIS – The Sisters of St. Francis Health Services Inc. and Anthem Blue Cross and Blue Shield in Indiana today (Aug. 31) announced a new multiyear contract that will maintain in-network healthcare benefits for policyholders and employer groups throughout Indiana.

The previous contract was set to expire Sept. 1.

The agreement covers the following SSFHS medical facilities and physicians:

· St. Francis Hospital & Health Centers (Indianapolis)
· St. Francis Hospital & Health Centers (Beech Grove)
· St. Francis Hospital & Health Centers (Mooresville)
· St. Elizabeth Regional Health (Lafayette)
· Home Hospital (Lafayette)
· St. Anthony Medical Center (Crown Point)
· St. Anthony Memorial Health Center (Michigan City)
· St. Margaret Mercy Healthcare Center (Hammond)
· St. Margaret Mercy Healthcare Center (Dyer)
· St. Clare Medical Center (Crawfordsville)
· Franciscan Physicians Hospital (Munster)
· Indiana Bone and Marrow Transplantation Unit (Beech Grove)
· More than 300 physicians throughout the SSFHS service areas

Health insurance plans covered are Anthem Blue Access PPO, Anthem Blue Preferred HMO, Anthem Traditional, Anthem Medicare Advantage PPO, Lumenos, Hoosier Healthwise (Indiana Medicaid) and Anthem Healthy Indiana Plan.

“We recognize how difficult this has been for our patients and appreciate their support and patience during the negotiations,” said Jay Brehm, SSFHS regional chief financial officer and chief negotiator for the hospital system. “The agreement we have forged, in the end, ensures our mission to provide patients with the timely and compassionate care they expect and deserve.”

“We are pleased to have reached this agreement with Sisters of St. Francis Health Services because it ensures that our customers will have uninterrupted, in-network access to medical care at SSFHS facilities across Indiana,” said David Lee, M.D., vice president of health services for Anthem Blue Cross and Blue Shield. “This contract achieves our number one goal of keeping health care affordable for our members.”

St. Francis, Anthem reach contract agreement in principle

INDIANAPOLIS – Anthem Blue Cross and Blue Shield and the Sisters of St. Francis Health Services, Inc. today (Aug. 29) announced they have reached an agreement in principle on a contract that will maintain in-network health care benefits for policyholders and employer groups throughout Indiana.

Final details are being ironed out, and we hope to have an official announcement soon.

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Frequently asked questions about the Anthem contract situation

Will Anthem’s contract terminate and when?

Unless a new contract is finalized before the effective date, St. Francis Hospital will be out of Anthem’s network effective September 1, 2009. The pending termination of the contract is the result of Anthem sending a termination notice to St. Francis Hospital earlier this year.

Are St. Francis and Anthem in contract discussions?

St. Francis and Anthem have been meeting over the recent months to work on issues that exist with Anthem’s proposed contract. Meetings have continued and we continue to pursue a new agreement before the deadline.

Is the “Billing Under Arrangements” mentioned by Anthem a violation of our existing contract?

St. Francis, like most hospital systems across the nation, provides a number of hospital services to patients living some distance from St. Francis’ three main hospital campuses by entering into business agreements with other healthcare providers, most notably with our employed physicians. In this way, St. Francis extends its healing ministry and exceptional medical services to patients throughout central and south-central Indiana.

Charges for hospital services provided in these outpatient and clinical facilities are billed at standard hospital rates in full compliance with all federal and state regulations. These services should not be considered physician services and, absent such arrangements, would not exist in outlying offices.

Anthem believes that that many of the health services provided by hospitals should only be available in the traditional hospital setting. Physicians and patients have asked St. Francis to provide these hospital services in communities and clinical settings beyond our three main campuses, and Anthem has been aware of these arrangements for several years. Anthem’s proposals would drastically reduce reimbursement for outpatient services provided by St. Francis Hospital and force us to withdraw many locations where outpatient services and testing are performed. This will create inconvenience for patients and physicians and will impact where St. Francis offers services.

Which health plans are being affected by Anthem’s notice?

Anthem is terminating all patient health care plans in which St. Francis Hospital is contracted to participate, including the following plans:

• Blue Traditional
• Blue Access PPO
• Blue Preferred HMO
• Lumenos
• FEP
• Healthy Indiana Plan (HIP)
• Medicare Advantage PPO plans.
  

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 these hospitals only through an Anthem contract. Without an Anthem contract, all BCBS plans will be accessing St. Francis Hospital out-of-network.

Are St. Francis employed physicians, St. Francis Medical Group (SFMG), being terminated?

At the moment, the contract terminations do not include SFMG but we do expect this to change. Insurance companies often require network physicians to have privileges at an in-network hospital. If St. Francis Hospital is out of Anthem’s network, our physicians that have privileges only with St. Francis Hospital may be terminated by Anthem as well.

Should patients cancel appointments?

Patients should maintain their appointments with the Hospital. The pending termination does not take effect until September 1st and dates of services before that date will all be considered in-network.

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 objection to Anthem and your employer. As always, you should follow your insurance plan’s pre-certification requirements.

What can patients do?

Anthem patients can contact their employer or the Indiana Department of Insurance to voice their concerns. Patients can also contact Anthem and voice concerns directly by calling the toll-free customer service phone number found on the identification card or by contacting David Lee, Vice President of Health Care Management with Anthem.

David Lee, M.D.
Telephone: (317) 287-6260
Vice President of Health Care Management
Anthem Blue Cross Blue Shield
220 Virginia Avenue
Indianapolis, IN 46204
Email: David.Lee@Anthem.com

Indiana Department of Insurance Consumer Helpline: 1(800) 622-4461

What phone number may patients use to directly call St. Francis?

Anyone can call St. Francis Hospital’s Toll-Free Anthem Hotline at (866) 576-3590. St. Francis Hospital is also posting timely updates to a page linked from its public Web site at www.stfrancishospitals.org. Information on the many other health plans that St. Francis Hospital participates with is available upon request.

updated Aug. 5, 2009, 12:25 p.m.

St. Francis health system remains in Anthem network; negotiations continue

The following is a SSFHS/Anthem joint news release:

INDIANAPOLIS – Based on a ruling yesterday (March 30) from the Marion County Superior Court-Civil Division in Indianapolis, Anthem Blue Cross and Blue Shield will continue to recognize facilities operated by the Sisters of St. Francis Health Services (SSFHS) as in-network until the contracts between Anthem and SSFHS expire Sept. 1, 2009.

Although Anthem had sought to terminate the contracts early, the court ruling means that members of Anthem health plans can continue to receive in-network services at SSFHS facilities after May 1.

The hospitals include:

• St. Francis Hospital & Health Centers in Beech Grove, Indianapolis and Mooresville
• St. Elizabeth Medical Center and Home Hospital in Lafayette
• St. Clare Medical Center in Crawfordsville
• St. Anthony Memorial Health Centers in Michigan City
• St. Anthony Medical Center in Crown Point
• St. Margaret Mercy Healthcare Center in Hammond and Dyer
• Franciscan Physicians Hospital in Munster.

The current Anthem-SSFHS contracts expire Sept.1, 2009. But leaders from both organizations emphasized they are committed to continuing contracts talks and securing a new long-term agreement to ensure that Anthem-insured patients receive in-network benefits at the highest level of care at all SSFHS hospitals.

Frequently asked questions about the Anthem contract situation

Will Anthem’s contract terminate and when?

St. Francis has received two termination notices from Anthem. The first notice of termination for an alleged breach of contract is effective May 1, 2009. St. Francis adamantly asserts that there is no breach of contract, and St. Francis is taking immediate steps to prevent this Anthem termination action from taking place.

The second Anthem termination notice pertains to the renewal of St. Francis’ contract with Anthem, and its termination is set for September 1, 2009. This contract is currently being negotiated and was set to renew unless either party served 180 days notice, which Anthem has now done. September 1, 2009 is the new deadline for completing a new contract with terms agreeable to both parties.



Are St. Francis and Anthem in contract discussions?

St. Francis hopes Anthem is willing to continue negotiations in a fair and honest fashion. But Anthem’s actions make it difficult for St. Francis to determine how Anthem plans to continue our discussions. Clearly, Anthem has pursued a course of action detrimental to ongoing negotiations.

Is the “Billing Under Arrangements” mentioned by Anthem a violation of the contract?

St. Francis, like most hospital systems across the nation, provides a number of hospital services to patients living some distance from St. Francis’ three main hospital campuses by entering into business agreements with other healthcare providers. In this way, St. Francis extends its healing ministry and exceptional medical services to patients throughout central and south-central Indiana. Charges for hospital services provided in these outpatient and clinical facilities are billed at standard hospital rates in full compliance with all federal and state regulations. Anthem wants to limit how and where Indiana patients can access hospitals care. Anthem believes that that many of the critical health services provided by hospitals should only be available in the traditional hospital setting. Physicians and patients have asked St. Francis to provide these hospital services in communities and clinical settings beyond our three main campuses, and as Anthem has been aware of these arrangements for several years.

Which health plans are being affected by Anthem’s notice?

Anthem intends to terminate all patient health care plans in which St. Francis is contracted to participate, including Blue Traditional, Blue Access PPO, Blue Preferred HMO, Lumenos, FEP, Healthy Indiana Plan (HIP) and Medicare Advantage PPO plans.

Are St. Francis employed physicians, St. Francis Medical Group (SFMG), being terminated?

No, the contract terminations do not include SFMG.

Should patients cancel appointments?

Patients should maintain their appointments with the Hospital. Anthem’s unwarranted and unfair negotiation tactics should not keep patients from seeking quality health care wherever they want Anthem’s actions are intended to do nothing more than bring patients and employers into the fray once again in an effort to pressure St. Francis into unfavorable and unreasonable business terms.

What can patients do?

Anthem patients should contact their employer or the Indiana Department of Insurance to voice their objections to Anthem’s unwarranted use of a contract termination as a way to force St. Francis Hospital into accepting extremely unfavorable and unfair new contractual terms.

Indiana Department of Insurance Consumer Helpline: 1 (800) 622-4461

What phone number may patients use to directly call St. Francis?

Anyone can call St. Francis Hospital’s Toll-Free Anthem Hotline at (866) 576-3590. St. Francis Hospital is also posting timely updates to a page linked from its public Web site at www.stfrancishospitals.org.

St. Francis ‘deeply disappointed’ by Anthem threat to terminate contracts

INDIANAPOLIS – After months of contract negotiations, the Sisters of St. Francis Health Services Inc. (SSFHS) is dismayed by Anthem Blue Cross and Blue Shield in Indiana’s notice that it would terminate contracts with SSFHS as early as May 1.

Anthem announced the termination in a March 3 communication to its insurance brokers and employer groups.

"We are deeply disappointed by Anthem’s action," said Kevin Leahy, SSFHS president and chief executive officer. "While progress throughout our negotiations has been slow and painstaking, there is a clear understanding between Anthem and SSFHS regarding the issues that keep the parties from agreeing to new contracts."

Leahy added, "Our patients remain our primary concern, and we will continue – as we have done throughout all phases of these discussions – to ensure Anthem-insured policyholders receive the level of benefits and quality of care they expect at all of our medical facilities."

Leahy emphasized that specifics of the negotiations fall under a mutually agreed upon confidentiality agreement, which SSFHS has strictly observed.

During negotiations last fall, SSFHS announced that it had rescinded the termination of the SSFHS contracts with Anthem because progress was being made in discussions. This action also guaranteed that Anthem-insured patients would continue to be served at St. Francis medical facilities throughout the state.

SSFHS officials believe Anthem’s termination announcement is a reaction to the hospital system’s filing of a lawsuit last November in Marion County Superior Court. The litigation, in part, pertains to the use of arbitration under current contracts between St. Francis and Anthem.

SSFHS’ other concerns are related to Anthem’s lack of timely claims reimbursement and the denial of claims related to their processing problems, a situation that has persisted since the fourth quarter of 2007.

The Indiana State Medical Association also has investigated similar problems with Anthem on behalf of its membership.

In a January 2009 report to its shareholders and posted on its Web site, Anthem said it generated net income of $2.5 billion in 2008. In 2007, Anthem generated $3.3 billion in net income for its shareholders. Anthem/WellPoint’s CFO predicts that Anthem will "generate significant positive cash flow in 2009" – standing in stark contrast to the struggle for financial survival facing every other Indiana business, working families and mission-driven hospitals like St. Francis.

Any inquiry into the causes of today’s health care crisis must consider the harmful impact of diverting multiple billions of premium dollars away from providing vital health services for working families.

A Feb. 22 Indianapolis Star article details the growth WellPoint/ Anthem has experienced and anticipates for its future. The article states: "WellPoint’s grip on its hometown health insurance market has more than doubled in the past five years, with nearly 70 percent of common policies now issued by the Indianapolis-based insurance giant… The growing market share gives WellPoint increasing clout in negotiating fees paid to doctors and hospitals throughout the region, contributing to a string of public feuds between WellPoint’s Anthem Blue Cross and Blue Shield and local health-care providers…"

Contracts currently cover the following SSFHS medical facilities and physicians:

• St. Francis Hospital & Health Center (Indianapolis)
• St. Francis Hospital & Health Center (Beech Grove)
• St. Francis Hospital & Health Center (Mooresville)
• St. Elizabeth Regional Health (Lafayette)
• Home Hospital (Lafayette)
• St. Anthony Medical Center (Crown Point)
• St. Anthony Memorial Health Center (Michigan City)
• St. Margaret Mercy Healthcare Center (Hammond)
• St. Margaret Mercy Healthcare Center (Dyer)
• St. Clare Medical Center (Crawfordsville)
• Franciscan Physicians Hospital (Munster)
• More than 300 physicians in the different SSFHS service areas

The affected plans are:

• Anthem Blue Access PPO
• Anthem Blue Preferred HMO
• Anthem Traditional
• Anthem Medicare Advantage PPO
• Lumenos
• Anthem Healthy Indiana Plan.