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.
