Anthem will ensure continuity of care for members
July, 2021
For many years, Anthem Blue Cross (Anthem) members have been able to receive in-network care from Dignity Health (Dignity), which unfortunately has become one of the more expensive health systems in California. Dignity issued contract termination notices to Anthem for the vast majority of its Anthem business and has now informed us that if we do not agree to substantial rate increases it will leave our health plans, making care at Dignity hospitals, medical groups and clinics unavailable to Anthem members. Anthem’s intent is to reach agreement on reasonable contractual language and reimbursement rates that will help protect affordability for consumers. We cannot, and will not, agree to excessive rate increases that will make care at Dignity even less affordable for those we serve.
Anthem is taking steps to help our members make seamless transitions to new care providers and facilities, and we are launching a continuity of care plan for people with special health circumstances, in case we are unable to reach an agreement with Dignity by July 15, 2021.
Why is this happening? Contractual relationships involve periodic negotiations, and for the past several months Anthem and Dignity have been in the process of negotiating a new contract to Dignity and its physicians in our members’ health plans.
Dignity rates are some of the highest among all health systems in California, making it almost 30 percent more expensive than other health systems in the state. For example, Dignity charges commercial insurance members in excess of 300 percent of the Medicare allowable rate for some services. If we were to give in to Dignity’s demands for excessive rate increases it would result in higher out-of-pocket and premium costs for our members. That’s something we just can’t do.
How Anthem is ensuring a seamless transition of care for our members
Impacted Members If we are unable to reach a new contract agreement by July 15, 2021, Dignity facilities will no longer be in our health plans for members enrolled in Commercial PPO, EPO, HMO, and POS benefit plans as well as some Medicaid and Medicare Advantage plans.
Impacted Facilities This also means the following Dignity facilities would no longer be in our health plans as of July 15, 2021:
Bakersfield Memorial Hospital
California Hospital Medical Center
Community Hospital of San Bernardino
Dominican Santa Cruz Hospital
French Hospital Medical Center
Glendale Memorial Hospital
Marian Medical Center
Marian Regional MC Arroyo Grande
Mark Twain St. Joseph’s Hospital
Mercy Healthcare Bakersfield
Mercy General Hospital
Mercy Hospital of Folsom
Mercy Medical Center - Merced
Mercy Medical Center – Mt Shasta
Mercy Medical Center – Redding
Mercy San Juan Hospital
Methodist Hospital of Sacramento
Northridge Hospital Medical Center
Sequoia Health Services
Sierra Nevada Memorial Miners Hospital
St. Bernardine Medical Center
St. John’s Regional Medical Center
St. John's Pleasant Valley Hospital
St. Elizabeth Community Hospital
St. Joseph’s Medical Center of Stockton
St. Mary Medical Center Long Beach
St. Mary’s Medical Center
St. Francis Memorial Hospital
Woodland Memorial Hospital
Alternate Facilities Members who need help locating an in-network hospital can call the toll-free member number listed on their Anthem member ID card or they can use the Find a Doctor function at anthem.com/ca/find-care.
Emergency Medical Care Emergency medical services are always considered a covered benefit and therefore do not require pre-authorization, regardless of where they are delivered. Anthem encourages consumers to make informed decisions about when to use urgent care as opposed to emergency room care. Urgent care is usually appropriate when you need a physician’s attention for a condition that is non-life threatening and your primary care physician is unavailable.
Continuity of Care Transition assistance to ensure in-network continuity of care would be available for Anthem members who are pregnant, undergoing a course of treatment, or who have obtained a prior authorization for services. Members can call the member services number on their Anthem member ID card to find out if they are eligible for continuity of care. Emergency medical services are always considered a covered benefit and therefore do not require pre-authorization, regardless of where they are delivered.
Staying Informed For the most up-to-date information refer to this site or members can call the member services number on their Anthem member ID card. This site will be updated as new information becomes available.