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Update on Negotiations Between Anthem Blue Cross and Stanford Health

September 01, 2022
 

Anthem Blue Cross (Anthem) continues to negotiate with Stanford Health (Stanford) to reach a new agreement that protects affordability for our Northern California consumers.

Stanford facilities and physicians left our care provider network effective September 1. Anthem and Stanford have a long history of partnership, and that’s why we are working hard to reach a new agreement that does not result in sharp increases in health care costs for our consumers.

The many businesses and consumers we serve in California trust us to deliver access to high-quality healthcare that is affordable. We value their trust in us and we take our responsibility very seriously.

Why has an agreement not been reached yet?

Contract discussions are a standard part of the health care industry and sometimes coming to agreement on affordability can take time. We are continuing to actively negotiate in good faith with Stanford and are hopeful we can find common ground to return them to our provider network.

Continuity of Care

The previous contract between Anthem and Stanford included provisions that cover members for continuity of care/completion of covered services after the contract terminates. Transition assistance to ensure in-network continuity of care would be available for Anthem members with certain conditions or who have obtained a prior authorization for services that are not available at alternate facilities. Members can call Anthem Blue Cross at the toll-free customer service number, 1-844-971-0117, or the toll-free member services number on their ID card to find out if they are eligible for continuity of care.

* HMO members and physicians wishing to request continuity of care/completion of covered services should contact their participating medical group.

Frequently asked questions (FAQ)

Q) Who is impacted by these negotiations?

This termination affects the out-of-pocket obligations for most Anthem Blue Cross members who are enrolled in Commercial PPO, EPO, HMO, and POS benefit plans and receive care at Stanford Health. Members who have Medicare Part C are affected, however, those with a Medicare supplemental policy for Part A and Part B (Medigap) are not affected by this contract termination.

 

Q: How can I stay up-to-date on Stanford’s status?

For the most up-to-date information, please continue to visit this site or call the Member Services number on your Anthem Blue Cross member ID card. This site will be updated as information becomes available.

 

Q) Which facilities and medical groups are affected by these negotiations?

Facilities

  • Stanford Hospital (HMO & PPO)
  • Lucile Packard Children’s Hospital (HMO & PPO)

Professional Medical Groups

  • Affinity Medical Group (HMO)
  • University Health Alliance Medical Group (PPO)
  • Lucile Packard Medical Group (PPO)
  • Stanford Healthcare Medical Group (PPO)
 

Q) Do Anthem members need to change doctors?

Many doctors have admitting privileges at more than one hospital. Just because a member’s doctor may have admitting privileges at Stanford Health does not necessarily mean that a doctor cannot treat his or her patients at another participating hospital. Anthem is continuing to provide access to other quality healthcare options that are in-network and will ensure a seamless transition for our members and other participating physicians. For a complete list of in-network care providers, members can use the Find a Doctor feature available on www.anthem.com/ca or call the Member Services number on your Anthem Blue Cross member ID card.

 

Q) What if an Anthem member chooses to receive care from Stanford anyway?

PPO and Traditional (Indemnity) Members:

Members enrolled in a DMHC-regulated benefit plan who elect to receive care at a non-contracting facility may be responsible for higher out of pocket expenses depending on benefit plan design (Note: There may be different arrangements for CDI-regulated benefit plans, ASO groups, or other self-insured clients.)

EPO Members:

Members enrolled in a DMHC-regulated benefit plan must stay within the EPO hospital network aside from true emergency situations.

HMO Members:

All services must be approved by the member's participating medical group. If approved, the claim will be covered at the member's in-network coverage schedule of benefits. If not approved by the member's participating medical group, and services are received at Stanford, the claim may be denied as stated in the member's Explanation of Coverage.

 

Q: What other participating Anthem network hospitals are available in the vicinity of Stanford facilities?

Anthem Blue Cross has a statewide hospital network of over 300 acute care facilities. The Find a Doctor function at www.anthem.com/ca can be used to locate a participating hospital in a specific area.

 

Q: What about members who need emergency medical care from a Stanford hospital following the contract termination date?

A hospital's emergency medical services are always considered a covered benefit regardless of where they are delivered. Coverage will be provided according to the member's policy benefits. If you are experiencing an emergency you should call 9-1-1 or seek treatment at the nearest emergency department.

Anthem encourages members to make informed decisions about when to use urgent care as opposed to emergency room care. Urgent care is usually appropriate when a member needs a physician's attention for a condition that is non-life threatening. A member who needs urgent care should go to the nearest immediate or urgent care facility when his or her physician or network provider is unavailable.