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Charlottesville Pathology Associates to leave Anthem Blue Cross and Blue Shield’s networks on September 5, 2019 

July 31, 2019
Anthem Blue Cross and Blue Shield in Virginia (Anthem) and our affiliate HealthKeepers, Inc. continue to work collaboratively with physicians, hospitals, ancillary providers and other health care professionals to help ensure our members have uninterrupted access to dependable, high quality health care at an affordable price through a broad and comprehensive provider network. Anthem and HealthKeepers, Inc. attempt to negotiate reasonable fees for services that physicians and other health care professionals and facilities provide as part of our network contracts with these providers. In fact, keeping health care costs fair for everyone is one of our main responsibilities.
 
Charlottesville Pathology Associates to leave Anthem’s networks on September 5, 2019
 
Recently, Anthem and HealthKeepers, Inc. received a contract termination notice from Charlottesville  Pathology Associates. Charlottesville Pathology Associates provides pathology services at Sentara Martha Jefferson Hospital at 500 Martha Jefferson Drive, Charlottesville, VA  22911.
 
If Charlottesville Pathology Associates does not rescind the termination, members in Charlottesville and surrounding areas of the state who enrolled in the following Anthem and HealthKeepers plans will need to be aware of the impact that this termination could have on them beginning September 5, 2019:
 
  •  Anthem’s PAR/PPO plans including the Blue Cross and Blue Shield Service Benefit Plan (also called the Federal Employee Program® or FEP)
  • Anthem HealthKeepers commercial plans including health plans purchased on or off the Health Insurance Marketplace (also known as the exchange)
  • Anthem HealthKeepers Plus (Medicaid/FAMIS and the Commonwealth Coordinated Care Plus plans)
  •  Medicare Advantage health plans
Please note that this notification ONLY applies to Charlottesville Pathology Associates. Sentara Martha Jefferson Hospital and all other hospital-based service providers at the medical center remain part of our Anthem PAR/PPO and Anthem HealthKeepers networks.   
Below is a list of Pathology providers that offer in-network services:
For all lines of business (including plans offered by HealthKeepers, Inc.):
 
  • LabCorp 
For PPO plans:
 
  • Quest Diagnostics
  • Greensboro Pathology
  • Blue Ridge Pathologists
  • PRW Laboratories
  • Propath
  • Pathologists Diagnostic Laboratory
  • Pathgroup Labs
Looking Ahead

We are hopeful that we can come to an agreement to keep Charlottesville Pathology Associates a participant in our provider networks.  Meanwhile, please continue to visit this site for the latest news and information on this topic. 
 
Frequently Asked Questions
 
Why is Charlottesville Pathology leaving the Anthem and HealthKeepers provider networks? 

While we do not disclose the specifics of our rate negotiations, what we can comment on is that Anthem's goal is to help ensure access to high quality, affordable health care, and one of the ways to help achieve that goal is to routinely analyze and rebalance professional fees charged for medical services. This is a targeted rebalancing of the professional standard rate schedule for covered services provided by Anthem's participating physicians and other medical providers, not an across the board rate reduction. In some states, for example, some providers such as primary care physicians and behavioral health providers will see an increase for certain services.
 
This evaluation includes competitive benchmarking, analysis of government reimbursement, consideration of changes in care delivery models and the impact of rate changes on our consumers. Anthem strives to maintain a robust network of providers who understand the affordability concerns shared by consumers across the country. 
 
What Anthem health plans would be affected?
 
  • Anthem’s PAR/PPO plans including the Blue Cross and Blue Shield Service Benefit Plan (also called the Federal Employee Program® or FEP) 
  • Anthem HealthKeepers commercial plans including health plans purchased on or off the Health Insurance Marketplace (also known as the exchange)
  • Anthem HealthKeepers Plus (Medicaid/FAMIS and the Commonwealth Coordinated Care Plus plans)
  • Medicare Advantage health plans
Is the hospital where Charlottesville Pathology Associates operates still a participating provider?

Yes. Sentara Martha Jefferson Hospital will remain a participating provider in Anthem's PPO and Anthem HealthKeepers' networks. The medical center and all other hospital-based service providers at Sentara Martha Jefferson Hospital will remain part of our Anthem PPO and HealthKeepers networks.   
 
If Charlottesville Pathology Associates leaves Anthem’s provider networks, are there other in-network providers in the area that members can use?

Yes. Other in-network professional providers are listed above.  For a complete list, members should visit anthem.com or call the customer service number on the back of their Anthem or HealthKeepers ID cards. 
 
In an emergency, members should continue to go to the nearest emergency room regardless of the participating status of the facility or the physician providers.  
 
How do members access customer service?

To ensure a smooth transition, members may also access our customer service team by dialing the number on the back of their ID cards. These representatives can address any questions or concerns our members may have. 
 
What happens if a member utilizes services provided by Charlottesville Pathology Associates on or after September 5, 2019?

Should Charlottesville Pathology Associates leave our networks on September 5, 2019, and members receive covered medical services from Charlottesville Pathology Associates on or after September 5, payment may be sent directly to the member based on the member's health plan and contract benefits. Consequently, members would then be responsible for paying Charlottesville Pathology Associates and may be subject to balance billing - the difference between the group's charges and the amount Anthem pays. To avoid the possibility of additional expenses, members may choose to use facilities that utilize in-network pathologists.
 
In a true emergency, members should seek treatment at the nearest hospital or emergency facility without regard to any providers' participation status. Emergency medical services do not require pre-authorization regardless of where services are delivered. The fact remains, however, that Charlottesville Pathology Associates may bill members for the difference between the billed charges and Anthem's payment on and after the effective date of the termination.