Augusta Health & Anthem
Reach an Agreement
Effective July 1, 2018
Augusta Health and Anthem have reached a new four-year agreement, effective July 1, 2018. Patients with Anthem insurance will have in-network coverage effective this date for Augusta Health and Augusta Medical Group services.
Frequently Asked Questions
1. Are services in the Augusta Health emergency room considered in network at this time?
Yes, all emergency services are considered in-network, including the Augusta Emergency Physicians practice.
2. If I am planning to deliver my baby at Augusta Health after July 1, 2018, will my delivery be covered in-network at Augusta Health?
Yes. Prenatal, delivery, and after-delivery care will be covered in-network.
3. When will my in-network claims be paid?
Just so you are aware, there may be an initial delay in the processing for Augusta Health and Augusta Medical Group claims while the new contract is being operationalized across the Anthem network. This is expected and we appreciate your patience.
4. Will I continue to receive payment checks from Anthem directly to cover services at Augusta Health?
For services received on or after July 1, Anthem will pay Augusta Health directly for those claims. However, for services received prior to July 1, you will continue to receive checks directly from Anthem; these should be forwarded to Augusta Health, along with your Explanation of Benefits (EOB).
Be aware, some of the services you received may be applied 100% to your deductible. In this case, you will receive an EOB and no check. Anthem was not and will not be providing this information to Augusta Health. It is important that you send the EOB to us in order for us to update your account and settle the balance due. Beginning in June, we have begun our follow up collection process in order to resolve outstanding balances. If you have an outstanding balance due, you can expect to receive a letter in the mail.
5. Now that Augusta Health is back in-network with Anthem, how will my out-of-pocket responsibility be affected
If your in-network deductible has not been met, allowable charges will be applied towards your in-network deductible, according to your specific Anthem plan. Based on your specific Anthem plan, any amount that you have paid in 2018 towards your out-of-network deductible may not apply ("carry over") towards your in-network deductible. You can contact the member services number on the back of your Anthem membership card for more information about your specific plan.
6. Now that you are back in network, can my out-of-network claims be re-filed with Anthem?
No, services rendered prior to July 1 will remain out-of-network. Unfortunately, by contract, we are not allowed to re-file those claims as in-network.
7. Is there anything else I should know?
Per Anthem, all outpatient radiology services, including mammograms and DEXA (bone density) scans, must be performed at the main hospital radiology department (78 Medical Center Drive, Fishersville). However, there are two exceptions:
- If your Urgent Care Center visit requires radiology services, those services can continue to be performed along with your Urgent Care visit.
- Patients who have Anthem as their secondary insurance will still be able to have radiology services performed on an outpatient basis at the Urgent Care Center locations and the Lexington Multi-Specialty Clinic.