Adventist Health and Anthem Blue Cross of California reach agreement on contract terms
UPDATE - August 11, 2022 - Adventist Health and Anthem Blue Cross announced they have reached a new contract agreement that provides Anthem health plan members with continued in-network access to hospital-based services at Adventist Health facilities.
“We are pleased to have reached a mutual agreement with Adventist Health that provides our members with continued access to care at Adventist Health facilities,” said John Pickett, regional vice president, Anthem Blue Cross. “The successful resolution of our discussions builds on our long-term partnership and shared commitment to providing access to high-quality care for those in the communities we serve.”
“We are pleased to continue our long working relationship with Anthem Blue Cross,” said Todd Hofheins, Chief Operating Officer, Adventist Health. “Our mission calls us to provide high quality care to patients in our communities and we’re excited to continue caring for Anthem Blue Cross members.”
The agreement affects Anthem Blue Cross members of the following individual health plans: Anthem PPO, EPO, HMO, Covered California (Exchange) EPO, HMO, Medicare Advantage PPO, HMO and Medi-Cal Managed Care HMO product lines.
The new agreement is effective immediately meaning Anthem Blue Cross members continue to have in-network access to Adventist Health hospitals and physicians in California.
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June 16, 2022
As Adventist Health continues to meet the health and well-being needs in the communities we serve, we are evaluating our payer contracts to ensure fair and equitable rates for our services. During this time, we want to reach out to our valued patients, community partners, trusted employers and our communities to let them know our current contract with Anthem Blue Cross of California is not sustainable, and we need to renegotiate our terms. We are making every effort to negotiate in good faith, but our current contract is set to expire at 12:01 a.m. on July 18, 2022, and we may be forced to terminate with the insurance company on that date.
As a not-for-profit, faith-inspired organization, we provide services in some of the poorest areas of California and throughout the past five years, have given away more than $276 million in charity care to those in need. Our commitment to the underserved has resulted in multiple years of negative operating financial performance. As a system, Adventist Health provides a hospital network across California and must have rate increases that support overall expenses that continue to exceed the reimbursement we receive.
Anthem Blue Cross has continued for the past two years to enjoy record profits, even in this highly inflationary environment. While Anthem raised members’ premiums annually, they continue to pay Adventist Health substantially less than other hospital systems. Anthem is one of our lowest paying health plans, and we can’t continue to provide quality care for patients at significantly reduced rates.
At Adventist Health, our first concern is always our patients. Adventist Health continues to negotiate with Anthem Blue Cross. We will update you should the current situation change. Please find attached some FAQs. If you have questions, please do not hesitate to contact us at 855-479-5196.
FAQs for patients
The following is a list of frequently asked questions regarding Adventist Health’s negotiations with Anthem Blue Cross of California PPO/HMO.
Q: What’s happening?
A: Adventist Health’s contract with Anthem Blue Cross of California PPO/HMO may terminate at 12:01 a.m. July 18. This may affect Anthem Blue Cross of California commercially insured patients.
Q: Why is this happening?
A: Anthem Blue Cross has continued for the past two years to enjoy record profits, even in this highly inflationary environment. While Anthem raised members’ premiums annually, they continue to pay Adventist Health substantially less than other hospital systems. Anthem is one of our lowest paying health plans, and we can’t continue to provide quality care for patients at significantly reduced rates.
Q: I am very concerned about this. What can I do?
A: If you receive healthcare coverage from your employer, your employer needs to know your concerns. Speak to your human resources department about your concerns.
Q: Can I still come to Adventist Health during the negotiations?
A: Yes, nothing changes during the negotiation period, which is prior to July 18, 2022. If you need hospital services at Adventist Health during this time, you will not be affected by the pending termination between Anthem Blue Cross of California PPO/HMO and Adventist Health.
Q: What does this mean if I am in the hospital on or after 12:01 a.m. July 18, 2022?
A: You will be covered by Anthem Blue Cross until you are discharged from the Adventist Health hospital. However, Anthem Blue Cross may elect to transfer you to another contracted hospital. Anthem Blue Cross may only transfer a patient if the transfer can be safely performed. You will need to confirm the details of your insurance benefit by calling your health plan customer service number on your insurance card. You can also use this number to ask your health plan if you are eligible to complete your current episode of care at the Adventist Health hospital as a continuity of care service.
Q: What if I have to go to the Emergency Department? Can I use my Anthem Blue Cross of California insurance?
A: You can always come to an Adventist Health hospital for medical emergencies. However, you should ALWAYS go to the nearest hospital in an emergency, regardless of your insurance coverage or ability to pay.
Q: What if I’m scheduled to deliver a baby or have a surgical or outpatient procedure, or receiving care for a chronic or terminal illness (such as cancer)?
A: Some members may be able to receive care for a period of time as a continuity of care service. You must receive specific authorization from Anthem Blue Cross for a continuity of care service. You should call the customer service number on your insurance card and ask about continuity of care service.
Q: I want to continue using Adventist Health. What can I do?
A: You should contact your health plan’s customer service number to ask about your benefits and out-of-network options for care.
Q: Will Adventist Health re-establish a contract with Anthem Blue Cross of California?
A: Adventist Health remains open to discussions. We will provide updates should the current situation change.
Q: I am an Anthem Blue Cross member. Who should I contact if I have more questions?
A: Please contact your health plan’s customer service number on your health plan insurance ID card. This will give you the most accurate and up-to-date information regarding your benefits and network. You may also contact the Department of Managed Health Care, which protects HMO consumers, at its toll-free number, voice 888-466-2219 or TDD 877-688-9891; or the California Department of Insurance Consumer Hotline at voice 800-927-4357 or TDD 800-482-4833.