St. Francis - Anthem Update

St. Francis Hospital & Health Centers is committed to serving its Anthem patients. This resource center will provide updates and answers to common questions about your coverage.

Wednesday, March 11, 2009

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.