If you thought that Anthem Blue Cross Blue Shield has given its local subscribers the rawest possible deal with its expulsion of Augusta Health from its network, get ready for more.
In some states Anthem has already rolled out what it calls Emergency Department Retrospective Reviews. If it sounds ominous, it could be. It means that if you go to the E.R. and are treated, but sometime down the road Anthem decides you didn't really need E.R. treatment, you can be left holding the entire bill. The website Vox.com recently profiled an Anthem subscriber who went to a hospital for pelvic pain, was kept for tests but who eventually faced a $12,000 bill when the insurance company declined to pay. As Vox notes: "The problem: These denials are made after patients visit the ER, sometimes based on the diagnosis after seeing a doctor, not on the symptoms that sent them."
– The News Leader Editorial Board
"As a Federal retiree with Anthem BCBS and currently having physical therapy, I became very concerned when I heard the Anthem – Augusta Health contract was expiring on December 31. I started dealing with Anthem on my own and felt I was getting nowhere or given the run-around. When I heard Augusta Health was providing Anthem Member Assistance I immediately went to the Business Office to utilize this service. I was there for no more than 30 minutes and 15 of that was the Augusta Health employee on hold with Anthem. When finally connected with Anthem, with her knowledge, she was able to ask the right questions and get the answers needed for my "continuity of care" request. The experience was extremely helpful and stress-free for me. I highly recommend this Augusta Health service to anyone who has Anthem BCBS insurance."
– Jan, Stuarts Draft
Augusta health is an independent, not-for-profit community hospital. What that means is that it serves its community, and ALL of the money it makes either goes into patient care, employee salaries or improving its facilities. It does not pay shareholders or investors. Its mission is to serve the community.
Anthem is a massive, for-profit corporation whose CEO made $16.5 million in 2016. Anthem makes money by having people subscribe to its insurance policies and then providing as little pay for as little care as it feels is necessary. The less it pays for care, the more profit it makes. The more profit it makes, the more it can pay its investors. The more profit Anthem makes, the higher its share price goes. Anthem's mission is to make money.
– Tom Pereles, MD – Shenandoah Valley Orthopedics & Sports Medicine
It certainly appears that the for-profit, multi-state insurance behemoth would rather cut sweetheart deals with one-size-fits-all chain hospitals. Nothing would be easier, and cheaper, for Anthem than dealing with just two or three networks in Virginia, so it's not tough to read these low-ball reimbursements as an attempt to forward that goal. Starve the little guys until they're weak enough that they have to sell out.
What matters is that Augusta Health is a community-based non-profit. It's working for us. It is the successor to the two community hospitals that served Staunton and Waynesboro until the early 1990s. And its goal is community service, with its excess income reinvested in the operation. The current emergency department expansion is a prime example.
– The News Leader Editorial Board
Every single conversation and situation is different and challenging in its own way... but ALL of them have a way of tugging on your heart strings. It was extremely busy, but that also means we helped a lot of people!! For that I am thankful to be a part.
– Katie, AHAMAC staff person
Having formerly worked at Augusta Health for many years, I know the high quality of care provided. I am amazed that some residents would consider supporting Anthem in the current negotiations. Augusta is and always has been a non-profit. Every dollar they get goes back into the community as services or payroll.
– Brad Tipler, MD – Waynesboro
I wanted my father to stay with his current physician and did not want him to have to travel to another provider. The staff filled out the continuation of care form for him, and spoke with us about financial assistance. We are so grateful for the help we received and were amazed at the complexity, but the staff knew exactly what to do.
– Karen, community member