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Pathology Sciences Medical Group PC to leave Anthem Blue Cross and Blue Shield’s networks on January 22, 2020

November 12, 2019
 
Anthem Blue Cross and Blue Shield in Virginia (Anthem) and our affiliate HealthKeepers, Inc. continue to work collaboratively with physicians, hospitals, ancillary providers and other health care professionals to help ensure our members have uninterrupted access to dependable, high quality health care at an affordable price through a broad and comprehensive provider network. Anthem and HealthKeepers, Inc. attempt to negotiate reasonable fees for services that physicians and other health care professionals and facilities provide as part of our network contracts with these providers. In fact, keeping health care costs fair for everyone is one of our main responsibilities.
 
Pathology Sciences Medical Group PC to leave Anthem’s networks on January 22, 2020
 
Recently, Anthem and HealthKeepers, Inc. received a contract termination notice from Pathology Sciences Medical Group PC. They provide pathology services at the following locations:
 
Pathology Sciences Medical Group
  • 2800 Godwin Blvd., Suffolk, VA  23434 (Located at Sentara Obici)
  • 830 Kempsville Rd. Norfolk, VA  23502 (Located at Sentara Leigh Hospital)
  • 600 Gresham Dr., Norfolk, VA  23456 (Located at Sentara Norfolk General Hospital)
  • 2025 Glenn Mitchell Dr., Virginia Beach, VA  23456 (Located at Sentara Princess Anne Hospital)
  • 3920 A Bridge Road, Suffolk, VA  23454 (Located at Sentara Belle Harbour)
  • 3000 Coliseum Place, Hampton, VA  23666 (Located at Sentara CarePlex Hospital)
  • 100 Sentara Circle, Williamsburg, VA  23188 (Located at Sentara Williamsburg Regional Medical Center)
  • 1060 First Colonial Road, Virginia Beach, VA 23454 (Located at Sentara Virginia Beach General) **Gynecology/Oncology Laboratory services only
If Pathology Sciences Medical Group PC does not rescind the termination, members in the Hampton Roads area of the state who enrolled in the following Anthem and HealthKeepers plans will need to be aware of the impact that this termination could have on them beginning January 22, 2020:
 
  • Anthem’s PAR/PPO plans including the Blue Cross and Blue Shield Service Benefit Plan (also called the Federal Employee Program® or FEP)
  • Anthem HealthKeepers commercial plans including health plans purchased on or off the Health Insurance Marketplace (also known as the exchange)
  • Anthem HealthKeepers Plus (Medicaid/FAMIS and the Commonwealth Coordinated Care Plus plans)
Please note that this notification ONLY applies to Pathology Science Medical Group PC, and all other hospital-based service providers at the medical centers remain part of our Anthem PAR/PPO and Anthem HealthKeepers networks.   
 
Below is a list of Pathology providers that offer in-network services:
  • General Hospital Pathologists, 1060 First Colonial Road, Virginia Beach, VA 23454 (Located at Sentara Virginia Beach General)
  • Hampton Roads Pathology, 736 North Battlefield Blvd., Chesapeake VA 23320 (Located at Chesapeake Regional Medical Center)
  • Peninsula Pathology Associates, 500 J. Clyde Morris Blvd., Newport News, VA  23601 (Located at Riverside Regional Medical Center)
  • Peninsula Pathology Associates, 120 Kings Way, Williamsburg, VA 23185 (Riverside Diagnostic Center)
  • Peninsula Pathology Associates, 7519 Hospital Drive, Gloucester, VA 23061 (Riverside Walter Reed Hospital)
  • Peninsula Pathology Associates, 850 Enterprise Parkway, Hampton, VA 23666  (Riverside Healthcare Center Hampton)
  • Peninsula Pathology Associates, 20480 Market Street, Onancock, VA 23417 (Riverside Shore Memorial Hospital)
  • Peninsula Pathology Associates, 1500 Commonwealth Avenue, Williamsburg, VA 23185 (Riverside Doctors’ Hospital Williamsburg)
  • Peninsula Pathology Associates, 12000 Warwick Boulevard, Newport News, VA 23601 (Riverside Peninsula Surgery Center)
  • Peninsula Pathology Associates, 618 Hospital Road, Tappahannock, VA 22560 (Riverside Tappahannock Hospital)
Available Laboratories
For all lines of business (including plans offered by HealthKeepers, Inc.):
  • LabCorp
For PPO plans:
  • Ameripath
  • Dominion Pathology Laboratories
  • Quest Diagnostics
Looking ahead
Please continue to visit this site for the latest news and information on this topic.
 
Frequently Asked Questions

Why is Pathology Sciences Medical Group PC leaving the Anthem and HealthKeepers provider networks?
While we do not disclose the specifics of our rate negotiations, what we can comment on is that Anthem’s goal is to help ensure access to high quality, affordable health care, and one of the ways to help achieve that goal is to routinely analyze and rebalance professional fees charged for medical services. This is a targeted rebalancing of the professional standard rate schedule for covered services provided by Anthem’s participating physicians and other medical providers, not an across the board rate reduction. In some states, for example, some providers such as primary care physicians and behavioral health providers will see an increase for certain services.
 
This evaluation includes competitive benchmarking, analysis of government reimbursement, consideration of changes in care delivery models and the impact of rate changes on our consumers. Anthem strives to maintain a robust network of providers who understand the affordability concerns shared by consumers across the country.
 
What Anthem health plans would be affected?
  • Anthem’s PAR/PPO plans including the Blue Cross and Blue Shield Service Benefit Plan (also called the Federal Employee Program® or FEP)
  • Anthem HealthKeepers commercial plans including health plans purchased on or off the Health Insurance Marketplace (also known as the exchange)
  • Anthem HealthKeepers Plus (Medicaid/FAMIS and the Commonwealth Coordinated Care Plus plans)
 
Are the hospitals where Pathology Sciences Medical Group PC practice at still participating providers?
Yes, the medical center and all other hospital-based service providers at Sentara hospitals will remain part of our Anthem PPO and HealthKeepers networks.  
 
If Pathology Sciences Medical Group PC leaves Anthem’s provider networks, are there other in-network providers in the area that members can use?
Yes, other in-network professional providers remain in the Hampton Roads area. For a complete list, members should visit anthem.com or call the customer service number on the back of their Anthem or HealthKeepers ID cards. We’ve also included a list of alternative providers above.
 
In an emergency, members should continue to go to the nearest emergency room regardless of the participating status of the facility or the physician providers. 
 
How do members access customer service?
To ensure a smooth transition, members may also access our customer service team by dialing the number on the back of their ID cards. These representatives can address any questions or concerns our members may have.
 
What happens if a member utilizes services provided by Pathology Sciences Medical Group PC on or after January 22, 2020?
Should Pathology Sciences Medical Group PC leave our networks on January 22, 2020, and members receive covered medical services from Pathology Sciences Medical Group PC on or after January 22, 2020, payment may be sent directly to the member based on the member’s health plan and contract benefits. Consequently, members would then be responsible for paying Pathology Sciences Medical Group PC directly and may be subject to balance billing - the difference between the group’s charges and the amount Anthem pays. To avoid the possibility of additional expenses, members may choose to use facilities that utilize in-network pathologists.
 
In a true emergency, members should seek treatment at the nearest hospital or emergency facility without regard to any providers’ participation status. Emergency medical services do not require pre-authorization regardless of where services are delivered. The fact remains, however, that Pathology Sciences Medical Group PC may bill members for the difference between the billed charges and Anthem’s payment on and after the effective date of the termination.