Patients with Anthem Blue Cross health insurance stopped having coverage at Stanford Hospitals and Clinics on Thursday (Sept. 1) after contract negotiations were not resolved, according to an Anthem document Palo Alto Online received yesterday.
The contract termination means that Stanford University Hospital, Lucile Salter Packard Children's Hospital (LPCH) and Stanford Medical Group might not be in the Anthem insurance-plan network. Authorizations and copay amounts could change for patients with the HMO and PPO plans, Lucile Packard spokesman Robert Dicks said.
The hospitals sent Anthem a letter on Feb. 25 informing the insurance giant of the termination on the contract's Sept. 1 expiration date.
The hospitals and Anthem have been in contract negotiations for several months to try to reach an agreement on reimbursement rates. Negotiations are ongoing, Dicks said. The two sides are close to an agreement, he said.
"The hospitals continue to work diligently with Anthem on negotiating new terms of agreement and are hopeful that a new contract will be signed as soon as possible. In the meantime, patients covered by Anthem Blue Cross HMO or PPO may still receive our world-class care.
"However, during what we hope will be a temporary and interim period, Anthem Blue Cross HMO members should continue to work closely with their primary care medical group for approval and authorization. Anthem Blue Cross PPO customers may have different co-pays and deductibles but should continue to have access to Stanford Hospitals and Clinics and LPCH facilities and physicians," he said.
If their primary-care physician is in one of the Stanford hospitals or the clinic, they might have to change physicians temporarily to receive authorizations from within their network. He said that patients should check with their medical group or with Anthem regarding their coverage.
If someone has Anthem Blue Cross HMO they can still receive care as long as Anthem Blue Cross or the patient's s primary care medical group provides authorization. However, Anthem Blue Cross has the right to redirect HMO patients to other contracted hospitals or physicians, Dicks said.
If a patient has Anthem Blue Cross PPO the patient might have different co-pays and deductibles. Elective procedures requiring pre-authorization, such as many outpatient surgeries, may not be approved by Anthem Blue Cross, he said.
The hospitals are also advising people to contact the Anthem Blue Cross Customer Service phone number listed on the back of their insurance card regarding continuity of care.
In its letter, Anthem said the California Department of Managed Health Care is requiring the insurance company to allow general enrollee access to Stanford medical Group until Sept. 16.
"Although Anthem will not publicly share details of its confidential contract negotiations, discussions with Stanford are ongoing," the company said in its statement.
"Because provider rates are the predominant driver of higher healthcare premiums, Anthem considers it our obligation to seek financial arrangements with network providers that result in competitive premiums for our members and clients.
"We are committed to ensuring that new contract rates remain profitable for Stanford. Nevertheless, given the current climate of health insurance reform, Anthem must maintain a balance between reasonable profits for hospitals and medical groups while providing member value."
California law requires Anthem to prepare for a potential hospital termination. The insurance carrier has submitted a transition-plan filing with the Department of Managed Health Care to ensure that patients have adequate health care after the medical group terminates from the insurance company.
Anthem has filed a transition plan for Stanford Medical Group that has been approved, with some conditions. Transplant patients can continue to receive services and will be reimbursed at in-network levels. Transplant patients at Stanford and Packard hospitals will also continue to receive care.
In-patients at Stanford hospitals will continue to receive uninterrupted care at in-network benefit levels. Doctors can also request continuity of care coverage, although that will be based on a number of factors, according to Anthem.
Emergency services can still be obtained at Stanford and Lucile Packard and do not require pre-authorization, the company said.