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Update on Anthem Blue Cross and Blue Shield in Ohio’s negotiations with Memorial Health System

November 25, 2019
Anthem Blue Cross and Blue Shield (Anthem) is actively engaged in price negotiations with Memorial Health System to reach a new agreement that protects access to affordable, high-quality health care for our consumers and keep Memorial Health in our provider network.
 
Memorial Health’s existing agreement with Anthem will end at midnight on January 31, 2020. Anthem and Memorial Health have a long history of partnership, and we recognize that having in-network access to Memorial Health is important to our members. That’s why we are working in good faith to reach an agreement that is fair doesn’t threaten to unreasonably increase healthcare costs for our consumers and their employers. During this time, we feel it is important to update our consumers of this potential change so they may plan accordingly for their healthcare needs.
 
If a new agreement isn’t reached before Feb. 1, 2020, Anthem will no longer have a contract with Memorial Health and its affiliated locations, physicians and ancillary providers. This does not mean you cannot use these providers, but care you receive from them will no longer be covered at an in-network benefit level for Anthem individual, employer-based and Medicare Advantage plans.
 
  • Starting February 1, Anthem consumers with plans that offer out-of-network benefits will receive reimbursement directly from Anthem for non-emergency services received at Memorial Health and be responsible for directly paying Memorial Health.  Your plan will cover these expenses at the out-of-network benefit level.
  • Starting February 1, Anthem consumers with HMO plans that do not offer out-of-network benefits will not be reimbursed for non-emergency services received from Memorial Health. 
As an out-of-network care provider, Memorial Health may choose to charge consumers above and beyond Anthem’s reimbursement in both of the above circumstances. (Note: Emergency services are always considered a covered benefit regardless of where they are delivered. See FAQ below.)
 
If Memorial Health leaves Anthem’s network, Anthem’s network will still include several other Southeast Ohio and West Virginia healthcare providers, including:
 
  • Camden Clark Medical Center
  • Genesis Health System
  • Southeastern Ohio Regional Medical Center
  • O’Bleness Hospital
Anthem is prepared to ensure a seamless transition to new care providers for our consumers. Anthem consumers can always use the Find a Doctor feature available at www.anthem.com/find-doctor or call the Member Services number on your Anthem member ID card to learn about alternative care options. For consumers that are currently receiving medical treatment, for a pregnancy for example, you may be eligible to continue receiving in-network benefits for care at your Memorial Health provider. Please see the FAQ section below.
 
The consumers, businesses, and communities we serve in Ohio trust us to deliver access to affordable, quality healthcare. We value your trust, and we take our responsibility very seriously.
 
Why has an agreement not been reached yet?
 
Contract discussions about the price charged for the care our consumers receive is a standard and routine part of the healthcare industry, and sometimes coming to agreement can take time. In any negotiation with providers, we strive to strike a balance between protecting affordability and providing choices for our consumers. We remain hopeful we can find common ground with Memorial Health.
 
Memorial Health has demanded double-digit price increases over the next 24 months, plus additional increases every year thereafter. Increases of this magnitude are significantly more than most Ohio workers’ wage increases and have the potential to put health care out of reach for the average person. These increases would place an unfair burden on individual consumers and employers in the form of higher copayments, deductibles, and premiums. We have offered Memorial Health price increases that are in line with inflation, and additional increases if Memorial Health meets agreed-upon quality of care measurements. In an effort to improve healthcare affordability for Ohio consumers, Anthem is leading efforts to partner with Ohio health systems to move to “fixed rate” pricing models that require both parties to agree to a set price for each service provided to our customers for the duration of the contract. Fixed rate pricing is the current best practice and future of healthcare reimbursement, yet Memorial Health has resisted movement toward this more predictable and sustainable model.
 
Anthem will continue to offer Memorial Health reasonable payment terms, a continued shift to quality-based healthcare, and fixed pricing models that have proven to improve health outcomes and moderate costs in other Ohio communities. In the event that an agreement is not reached with Memorial Health, Anthem will continue to have quality healthcare alternatives for our members.
 

Frequently Asked Questions (FAQ)

 
Q: Who is impacted by these negotiations?
Anthem consumers in Ohio who are covered by employer-based and individual commercial health plans, as well as those covered by Medicare Advantage plans are impacted.
 
Q: How can I stay up-to-date on the status of these negotiations?
For the most up-to-date information refer to this site at www.anthem.com/memorial or call the Member Services number on your Anthem member ID card. This site will be updated as information becomes available.
 
Q: Which facilities and medical groups are affected by these negotiations?
 
All Memorial Health System facilities, services and physicians are impacted, including:
 
Health Care Facility/Provider County
Memorial Health Hospital Washington
Selby General Hospital Washington
Marietta Surgery Center Washington
Marietta Healthcare Physicians Washington, Monroe, Athens, 
Noble, & Wood County WV
MHC Physicians, Inc. Washington, Monroe, Athens, 
Noble, & Wood County WV
 
Q: What about people who need emergency medical care from a Memorial Health hospital after the contract termination date?
Emergency medical services are always considered a covered benefit and therefore do not require pre-authorization, regardless of where they are delivered. If you are experiencing an emergency you should call 9-1-1 or seek treatment at the nearest emergency department. Coverage will be provided according to the member’s policy benefits.
 
Anthem encourages consumers to make informed decisions about when to use urgent care as opposed to emergency room care. Urgent care is usually appropriate when you need a physician’s attention for a condition that is non-life threatening and your primary care physician is unavailable.
 
Q: Will Anthem’s consumers need to change doctors?
Most health plans offer benefits for care received at out-of-network healthcare providers. Consumers should consult their plan documents or call Anthem Customer Service to understand the out-of-network benefits offered by their health plan.
 
  • After January 31, Anthem consumers with plans that offer out-of-network benefits will receive reimbursement directly from Anthem for non-emergency services at Memorial Health and will be responsible for paying Memorial Health. As an out-of-network care provider, Memorial Health may choose to charge fees above and beyond Anthem’s reimbursement.
  • Starting February 1, Anthem consumers with HMO plans that do not offer out-of-network benefits will not be reimbursed for non-emergency services received from out-of-network providers. Using in-network healthcare providers is always the most affordable way for consumers to access healthcare services.
If Memorial Health leaves Anthem’s network, Anthem’s network will still include other healthcare providers including Camden Clark Medical Center, Sistersville General Hospital, Genesis Health System, Southeastern Ohio Regional Medical Center, O’Bleness Hospital and others. Anthem is prepared to ensure a seamless transition to new care providers for our consumers. Anthem consumers can always use the Find a Doctor feature available at www.anthem.com/find-doctor or call the Member Services number on your Anthem member ID card to learn about alternative care options.
 
Q: What other participating Anthem network hospitals are available in the vicinity of Memorial Health facilities?
Thanks to the breadth of Anthem’s network, Anthem consumers will still have access to an extensive network of hospitals and physicians in the area. A listing of hospitals within close proximity to Memorial Health System includes:
 
Facility Address County
Camden Clark Medical Center 800 Garfield Avenue
Parkersburg, WV 26101
Wood County, WV
Sistersville General Hospital 314 S Wells Street
Sistersville, WV 26175
Tyler County, WV
O'Bleness Memorial Hospital 55 Hospital Drive
Athens, OH 45701
Athens County, OH
Wetzel County Hospital 3 E Benjamin Drive
New Martinsville, WV 26155
Wetzel County, WV
Barnesville Hospital 639 W Main Street
Barnesville, OH 43713
Belmont County, OH
Southeastern Med 1341 Clark Street
Cambridge, OH 43725
Guernsey County, OH
Roane General Hospital 200 Hospital Drive
Spencer, WV 25276
Roane County, WV
Jackson General Hospital 122 Pinnell Street
Ripley, WV 25271
Jackson County, WV
Genesis HealthCare System 2951 Maple Avenue,
Zanesville, OH 43701
Muskingum County, OH
 
Q: What about situations in which it’s medically necessary for people to stay with their current Memorial Health doctor or care provider?
 
Consumers should contact their Memorial Health care provider and ask him or her to request Continuity of Care consideration from Anthem. Consumers may also call Anthem’s Customer Service Center at the number on their ID card. Conditions under which in-network benefits may be granted for care at Memorial Health after Jan. 31, 2020 include:
 
  • The consumer is in an active course of treatment for an acute medical condition, behavioral health condition, or serious chronic condition.
  • The consumer is in the second or third trimester of a pregnancy.
  • The consumer has a terminal illness.