Antelope Valley Medical Center Terminates Contract with Anthem Blue Cross
August 15, 2023August 15, 2023
Antelope Valley Medical Center (AVMC) has chosen to terminate its Commercial and Medicare Advantage contracts with Anthem Blue Cross (Anthem), effective August 15, 2023. This could affect the out-of-pocket obligations for Anthem members enrolled in commercial PPO, EPO, HMO, POS and Medicare Advantage HMO/PPO benefit plans and receive non-emergency care at AVMC.
As a long-time trusted health partner, Anthem has been serving Californians for more than 85 years, including those in the Antelope Valley. Anthem members continue to enjoy in-network care at other local facilities in the area. Members who need assistance locating an in-network hospital, medical group, or urgent care center can call the toll-free member number listed on their Anthem member ID card or they can use the Find Care Tool at https://www.anthem.com/ca/find-care/.
Note that Anthem members can still utilize AVMC for emergency services as emergency medical services are always considered a covered benefit no matter where the care is provided. Members who are in a current course of treatment at AVMC will continue to receive those services, and Anthem is working collaboratively with AVMC, as well as the physicians and medical groups that maintain admitting privileges at the AVMC, to ensure there are no gaps in coverage and members continue to receive the right care, in the right setting at the right time.
Why is this happening?
Contract discussions are a standard part of the health care industry and sometimes coming to agreement can take time. Earlier this year, AVMC issued a termination notice to Anthem with the intent to renegotiate a new contract agreement. While we were engaged in good faith negotiations with AVMC for several months, we were unable to find common ground on a new contract. As part of a new contract AVMC wanted to significantly raise prices for our members and customers. Agreeing to AVMC’s new contract terms would create a significant financial burden for local families and businesses. We firmly believe our care providers should be reimbursed fairly, including AVMC, and that was reflected in our offers during these negotiations. However, AVMC rejected all offers, made the decision to not extend the current agreement and terminated the contract.
Now more than ever, as Californians are facing some of the highest inflation in decades, we need to ensure stability and continued access to affordable health care services. Any increases in local health care costs are dollars taken out of the pockets from local employers and families.
What does this mean for Anthem members?
As of August 15, 2023, AVMC facilities are no longer part of Anthem’s provider network and will be out-of-network for Anthem members.
Other Local In-Network Facilities
Anthem members continue to enjoy in-network care at other local facilities in the area, including Palmdale Regional Medical Center. Members who need help locating an in-network hospital, medical group, or urgent care center can call the toll-free member number listed on their Anthem member ID card or they can use the Find Care Tool at https://www.anthem.com/ca/find-care/.
Emergency Medical Care Still Accessible at AVMC
Anthem members can still utilize AVMC for emergency services as emergency medical services are always considered a covered benefit no matter where the care is provided. Anyone in need of emergency care should immediately go to the nearest emergency room or call 9-1-1. Coverage will be provided according to the member’s heath care policy benefits.
Continuity of Care
Transition assistance to ensure in-network continuity of care would be available for Anthem members who are pregnant, undergoing a course of treatment, or who have obtained a prior authorization for services. Members can call the member services number on their Anthem member ID card to find out if they are eligible for continuity of care.
Frequently Asked Questions
- What Anthem members are impacted?
- As of August 15, 2023, AVMC is no longer part of Anthem’s provider network. This could affect the out-of-pocket obligations for Anthem members enrolled in Commercial PPO, EPO, HMO, POS and Medicare Advantage HMO/PPO benefit plans, and receive non-emergency care at AVMC. Anthem Medi-Cal members are not impacted in this termination.
- What other local facilities are in-network for Anthem members?
Anthem Blue Cross members continue to enjoy in-network care at the other local care facilities in the area, including Palmdale Regional Medical Center. Members can local in-network facilities and doctors with the Find Care function at www.anthem.com/ca or call the Anthem Blue Cross toll-free member services number on their ID card with any questions.
- What if an Anthem member needs emergency care?
- Emergency services at AVMC are not impacted. Regardless of a contract termination, Anthem members can continue to access AVMC for emergency services, as those services are always considered a covered benefit regardless of where they are performed.
- Members seeking non-emergency care should look for services at a local in-network facility. Members can access the Find Care function at www.anthem.com/ca to locate a participating hospital in a specific area or call the toll-free member services number on the back of their Anthem member ID card.
- What about Anthem members who are in a current course of treatment at AVMC?
- Anthem members who are in a current course of treatment at AVMC will continue to receive those services.
- Anthem members with certain medical conditions -- like cancer, pregnancy, chronic illness -- may qualify to continue their services at AVMC under Anthem’s Continuity of Care program for specified periods of time. Members may apply for this service by contacting their treating physician or by calling the Anthem Blue Cross toll-free member services number on their ID card.
- Anthem members who are authorized or scheduled for a service or procedure at AVMC after August 15, 2023, will be notified and, absent approved continuity of care, the services will be transitioned to another in-network facility.
- Anthem Blue Cross has already notified admitting HMO medical groups and physicians who maintain privileges/affiliations at AVMC of the potential contract termination. Anthem encouraged these physicians and medical groups to obtain alternate admitting privileges and/or arrange for the redirection of members to alternate participating hospitals for non-emergency care services.
- Anthem is working collaboratively with AVMC, as well as the physicians and medical groups that maintain admitting privileges at the AVMC, to ensure a smooth transition for our members and ensure they continue to receive the right care, in the right setting at the right time.
- Members can call Anthem Blue Cross at the toll-free member services number on their ID card with any questions regarding their benefits.
Staying Informed
