Anthem Information

Frequently Asked Questions

Here are some common questions and answers about Augusta Health being out of network with Anthem.

1. How do I find out what it means for "me" to be out of network?

Augusta Health has set up the Augusta Health Anthem Member Assistance Center (AHAMAC) to help Anthem members navigate their benefits given their individual health care needs. Before assuming that your care can't be provided by Augusta Health, take advantage of this service. You can call (540) 245-7565 to schedule an appointment or get assistance over the phone or you can visit us in the Augusta Health Business Office on campus, Monday – Friday, 9:00 AM – 6:00 PM.

2. Will I need to find a new PCP?

As of 2/1/2018, the Augusta Medical Group is out of network with Anthem. Before you consider changing your physician, please call the Augusta Health Anthem Member Assistance Center (AHAMAC) at (540) 245-7565. A representative will be available to assist you. The center is open Monday – Friday, 9 AM – 6 PM and is located in the Business Office on campus at Augusta Health.

3. If my specialist is in-network (Anthem Provider), but Augusta Health is not in-network, will I be able to go to Augusta Health? Will this cost me more?

If you visit an in-network specialist at Augusta Health while the hospital is out of network with Anthem, your insurance company can subject you to out-of-network rates regardless of your specialist's network status. Each health plan is unique to that particular member based upon the specifics of the insurance plan, so we encourage all Anthem patients to call our team at the Augusta Health Anthem Member Assistance Center (AHAMAC) at (540) 245-7565. A support team is available Monday – Friday from 9:00 AM – 6:00 PM for assistance. You can call to schedule an appointment/Walk-ins welcome.

4. What is Continuation of Care (COC)?

For designated periods of time Anthem will extend in-network coverage beyond the contract. Below are the four circumstances in order for there to be minimal disruption to patients. This coverage is required by Virginia law.

  1. Inpatients admitted prior to expiration of Contract – coverage is provided at the same rate up to ninety (90) days.
  2. Outpatients under an active course of treatment prior to expiration of Contract – coverage at same rates up to ninety (90) days.
  3. Pregnant patients in second or third trimester – coverage is provided at in-network rates through postpartum care for care directly related to the delivery.
  4. Terminally ill patients covered at in-network rates through the remainder of their life for care directly related to the terminal illness.

Emergency Services: the Bureau of Insurance has clarified that payments for EMTALA services should be made the same way to out of network providers as participating providers – directly to the provider.

5. What will happen if I'm in the midst of treatment for a chronic disease?

Certain patients, including those hospitalized, in their second or third trimester of pregnancy, or currently undergoing a course of treatment with providers from Augusta Health, may be eligible to continue their course of treatment with their Augusta Health providers as part of the Continuity of Care transitional period. The length of the transitional period depends on the specific health plan. Patients should call the phone number on the back of their Anthem BCBS insurance card to find out if they are eligible and apply.

All Anthem patients should contact the Augusta Health Anthem Member Assistance Center (AHAMAC) for questions or assistance by calling (540) 245-7565. A support team is available Monday – Friday from 9:00 AM – 6:00 PM for assistance. You can call to schedule an appointment/Walk-ins welcome.

6. Will I be able to deliver my baby at Augusta Health if I'm due after 12/31/17?

Certain patients, including those hospitalized, in their second or third trimester of pregnancy, or currently undergoing a course of treatment with providers from Augusta Health, may be eligible to continue their course of treatment with their Augusta Health providers as part of the Continuity of Care transitional period. The length of the transitional period depends on the specific health plan.

Patients should call the Augusta Health Anthem Member Assistance Center (AHAMAC) at (540) 245-7565. A support team is available Monday – Friday from 9:00 AM – 6:00 PM for assistance. You can call to schedule an appointment/Walk-ins welcome.

7. Can I use the Emergency Department? And will it cost me more?

Even without a new contract, Virginia state law protects patient access to Augusta Health when they need emergency care. Our emergency room is always open to all patients, and the cost for emergency services is not impacted based a patient's network status.

8. What happens if I'm admitted from the Emergency Department to Augusta Health?

Patients are entitled to emergency care at any hospital until they are stabilized. Once stabilized, authorization will be required from Anthem for Augusta Health to continue providing a patient care in-network. Instead of providing authorization, Anthem may request that the patient be transferred to an in-network facility, at which time the patient can choose between being transferred, or incurring additional out of pocket costs to continue receiving care at Augusta Health as an out-of-network patient.

9. What can I do to make a difference to support Augusta Health in this situation?

  • Call Anthem. Call the number on the back of your insurance card, and urge Anthem to come to an agreement with Augusta Health.
  • Take a Stand with us: Call the Anthem Virginia Northern Region Office, at (804) 354-3622 to let them know how important it is that Augusta Health be in network with Anthem.
  • Talk to your HR manager. If you get insurance through your employer, contact your HR department. Ask that they reach out to Anthem and urge them to reach an agreement with Augusta Health. Or, ask your employer to explore other health insurance options that have Augusta Health provider's in-network.
  • Contact the Centers for Medicare and Medicaid Services (CMS). If you have a Medicare Advantage plan, call CMS to let them know the importance of keeping your in-network access to Augusta Health providers. You can call CMS directly at (800) 633-4227.
  • Contact the Virginia Department of Insurance. Call Jacqueline K. Cunningham, Commissioner of Insurance, at (804) 371-9741 and ask that she urge Anthem to make a deal with Augusta Health.

10. What does it mean for me if I have to pay out-of-network rates?

While all insurance plans are different, out-of-network costs more for the patient out of their pocket than in-network.

We encourage all Anthem patients to call our team at the Augusta Health Anthem Member Assistance Center (AHAMAC) at (540) 245-7565 for assistance. The center is open Monday – Friday, 9:00 AM until 6:00 PM.

11. Does Augusta Health accept other Commercial insurance carriers, and can I switch insurance companies?

We have relationships with several of the other major health insurance networks. We will be in network with the following health plans in 2018:

Accepted Insurance:

  • Aetna
  • America's Choice Provider Network (ACPN)
  • Anabaptist Healthshare
  • Anthem (in contract negotiations)
  • Cigna
  • Humana
  • Magellan Complete Care
  • Molina Healthcare (Medicare/Medicaid)
  • Sentara Optima
  • United Healthcare (UHC)
  • VA Choice
  • Virginia Health Network
  • Virginia Premier

Medicare:

  • Aetna Medicare
  • Anthem
  • Humana
  • Molina Healthcare (Medicare/Medicaid)
  • United Healthcare (UHC)

12. Does this affect Medicare patients with Anthem supplemental insurance?

No. Anthem Medicare Supplemental plans (also known as MediGap health plans) are not impacted. You will continue to have in-network access to all Augusta providers.

13. Does this apply to BC MA products (Medallion Medicaid, Anthem Healthkeepers Plus)?

Yes. We are currently negotiating with Anthem to renew our Medicare Advantage contracts, as well as employer-sponsored plans and health plans purchased through the Health Insurance Exchange.

14. What will happen to Augusta Health if there is no contract with Anthem? Will employees be laid-off?

Anthem pays Augusta Health and the employed physicians less than other health systems in our region for the same or better healthcare services. We are also the community's largest employer and the economic engine for the county. Unless we fix our contract with Anthem, our long-term ability to deliver on the care our community relies on will be in jeopardy.

15. Will Augusta Health be able to continue developing state-of-art healthcare?

By investing in top clinical talent, technology, and new capabilities, we have built a high quality health system that can meet the healthcare needs of our community right here at home. Our effort has earned us one of the highest accolades for healthcare providers, the "America's Best 50 Hospitals" award, for the last three years. Unless we fix our contract with Anthem, our long-term ability to deliver on the care our community relies on will be in jeopardy.

16. If Augusta Health needs more money from Anthem, how can Augusta Health afford ED expansion and hiring more physicians?

Fortunately, Augusta Health has had a substantial amount of support in the form of donations from residents of our community. A great deal of our investments, including the recent Emergency Department expansion and openings of specialty clinics, happen because of the generosity of our community, not from what we are paid to provide care. Augusta Health is the community's largest employer and the economic engine for the county. We also manage our resources very carefully. Because of our stewardship, we are the lowest cost provider in our region.

17. When will I know if the contract expires, and when will this take affect?

  • The Augusta Health contract expired on 12/31/2017
  • The Augusta Medical Group (AMG) contract expired on 1/31/2017

18. Does the Anthem contract apply to children?

Yes. Our current Anthem contract impacts patients of all ages.

Certain patients, including those hospitalized, in their second or third trimester of pregnancy, or currently undergoing a course of treatment with providers from Augusta Health, may be eligible to continue their course of treatment with their Augusta Health providers as part of the Continuity of Care transitional period. The length of the transitional period depends on the specific health plan.

Patients should call the Augusta Health Anthem Member Assistance Center at (540) 245-7565 for assistance.

19. Should I contact my local and Federal Legislators to express my concerns?

Yes. We urge you to call and/or email your local and Federal legislators to let them know the importance of keeping your in-network access to Augusta Health. You can find a complete list of elected officials at: www.augustava.com/area-officials/

20. If Augusta Health does not have a contract how much money will Augusta Health lose?

Anthem is the state's largest insurer and, because of that, a significant portion of the revenue we get from treating insured patients comes from them. While the prospect of not having a new contract with Anthem is a concern financially, we believe it's vital for us to take a stand for our patients by advocating for fair rates that fix our contract. Because without it, we're staring at more daunting financial challenges that will undermine our sustainability in the future.

21. Why does Anthem pay other hospitals more money?

For more than seven years, Anthem has paid Augusta Health significantly less than other hospitals in our region for the same, or better, care we provide to our patients. We haven't fought for what we deserve and, in the spirit of maintaining a good partnership, have agreed to take what's been offered by Anthem, which has been well below-market. With all of the other cuts to reimbursement through the ACA, lack of Medicaid expansion in Virginia, shift of care to outpatient settings and observation care, we believe it is now essential to take a strong stand by advocating for fair rates that fix our contract and ensure Augusta's stability for our patients for the future. We are asking for reimbursement rates in keeping with what other providers in our region receive from Anthem, nothing more, nothing less.

Augusta Health Anthem Member Assistance Center (AHAMAC)

(540) 245-7565
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