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Update on Negotiations Between Anthem Blue Cross and Stanford Health

September 11, 2019
 
Anthem Blue Cross (Anthem) is committed to improving lives and communities and making healthcare simpler and more accessible for consumers. Anthem continues to negotiate with Stanford Health (Stanford) in an effort to reach a new agreement that protects affordability for our Northern California consumers and returns Stanford to our provider network.
 
Stanford made the decision to end their facility and professional agreements with Anthem on August 31, 2019. Anthem and Stanford have a long history of partnership, and we recognize that having in-network access to Stanford is important to our members. That’s why we continue to work hard to reach a new agreement that is fair and that does not threaten to unreasonably increase healthcare costs for our consumers. Unfortunately, the latest offers from Stanford do not accomplish that.
 
Because an agreement on new contracts or an extension was not reached by 11:59 p.m. on August 31, 2019, Stanford unfortunately is no longer currently participating in Anthem’s network.
 
As an agreement or extension was not reached before the previous contract ended, members who continue to utilize Stanford facilities and physicians will receive out-of-network coverage for those services if included in their benefit plan. However, because these services are out-of-network we cannot guarantee Stanford will not bill members for the difference between the Anthem allowed reimbursement and Stanford’s billed charges. That is why Anthem is continuing to provide access to other quality healthcare options that are in-network for our consumers, and is ensuring a seamless transition for our members and other participating physicians.
 
The many businesses and consumers we serve in California trust us to deliver access to high-quality healthcare that is affordable. We value their trust in us and we take our responsibility very seriously.
 
Why has an agreement not been reached yet?
 
Stanford made the decision to terminate its contract with Anthem, and we are standing firm because consumers need greater affordability and the latest offers from Stanford do not accomplish that, as they are demanding increases that are nearly double what other hospitals are receiving. We are continuing to actively negotiate in good faith with Stanford and are hopeful we can find common ground to return them to our provider network.
 
Continuity of Care   
 
If an Anthem Blue Cross member began a course of treatment with Stanford before the close of the transition period for one of the following conditions, he or she may be eligible to receive continuity of care:
 
  • The member is in an active course of treatment for an acute medical condition, behavioral health condition, or serious chronic condition.
  • The member is pregnant, regardless of trimester.
  • The member has a terminal illness.
  • The member is a child between the ages of birth and 36 months.
  • The member has a surgery or other procedure that was authorized before September 1, 2019, and is scheduled within 180 days after the contract’s termination date.
When a case is approved for continuity of care through Anthem’s Transition Assistance Unit*, the claim is processed at in-network benefit levels. Once a member is determined to be eligible for transition assistance, the member is only financially responsible for applicable deductibles, coinsurance and/or co-payments. If an Anthem Blue Cross member does not meet the requirements for transition assistance, then continuity of care will not be provided. In this situation, the provider will be considered out-of-network and the member, if he or she chooses to receive care from the provider, may incur significant out-of-pocket expense, depending on their benefit structure.
 
* HMO members and physicians wishing to request continuity of care/completion of covered services should contact their participating medical group.
 
Frequently asked questions (FAQ)
 
Q) Who is impacted by these negotiations?
 
Anthem members in California who are covered by an employer-sponsored commercial plan are impacted by these negotiations; members receiving coverage through Medicare or Medicaid would not be impacted.
 
Q: How can I stay up-to-date on Stanford’s status?
 
For the most up-to-date information, please continue to visit this site or call the Member Services number on your Anthem Blue Cross member ID card. This site will be updated as information becomes available.
 
Q) Which facilities and medical groups are affected by these negotiations?
 
The Stanford locations that would be affected, in the event that an agreement is not reached with Stanford by August 31, 2019, are:
 
Facilities
  • Stanford Hospital (HMO & PPO)
  • Lucile Packard Children’s Hospital (HMO & PPO)
Professional
  • UHA Medical Group (PPO)
  • Stanford Healthcare Medical Group (PPO)
  • Lucile Packard Medical Group (PPO)
Q) Do Anthem members need to change doctors?
 
Anthem is continuing to provide access to other quality healthcare options that are in-network for our consumers, and is ensuring a seamless transition for our members and other participating physicians. For a complete list of care providers, use the Find a Doctor feature available on www.anthem.com/ca or call the Member Services number on your Anthem Blue Cross member ID card.
 
Q: What if an Anthem member chooses to receive care from Stanford anyway?
 

PPO and Traditional (Indemnity) Members:

 
Members enrolled in a DMHC-regulated benefit plan who elect to receive care at a non-contracting facility may be responsible for higher out of pocket expenses depending on benefit plan design (Note: There may be different arrangements for CDI-regulated benefit plans, ASO groups, or other self-insured clients.)
 

EPO Members:

 
Members enrolled in a DMHC-regulated benefit plan must stay within the EPO hospital network aside from true emergency situations.
 

HMO Members:

 
All services must be approved by the member’s participating medical group. If approved, the claim will be covered at the member’s in-network coverage schedule of benefits. If not approved by the member’s participating medical group, and services are received at Stanford, the claim may be denied as stated in the member’s Explanation of Coverage.
 
Q: What other participating Anthem network hospitals are available in the vicinity of Stanford facilities?
 
Anthem Blue Cross has a statewide hospital network of over 300 acute care facilities. The Find a Doctor function at www.anthem.com/ca can be used to locate a participating hospital in a specific area. The following is a partial list of alternate participating general acute care hospitals in the Stanford service area:
 
Stanford Hospital:
  • El Camino Hospital-Mountain View, 2500 Grant Road, Mountain View, CA 94040
  • Menlo Surgical Hospital, 570 Willow Rd, Menlo Park, CA 94025
  • Mills Peninsula Medical Center-San Mateo, 100 S. San Mateo Dr., San Mateo, CA 94401
  • Sequoia Hospital, 170 Alameda De Las Pulgas, Redwood City, CA 94062
  • St. Rose Hospital, 27200 Calaroga Ave., Hayward, CA 94545
  • UCSF Benioff Children’s Hospital, 505 Parnassus Ave., San Francisco, CA 94143
  • UCSF Medical Center, 505 Parnassus Ave., San Francisco, CA 94143
Lucile Packard Children’s Hospital:
  • El Camino Hospital-Mountain View, 2500 Grant Road, Mountain View, CA 94040
  • El Camino Hospital-Los Gatos, 815 Pollard Road, Los Gatos, CA 95032
  • Menlo Surgical Hospital, 570 Willow Rd, Menlo Park, CA 94025
  • Mills Peninsula Medical Center-Burlingame, 1501 Trousdale Dr., Burlingame, CA 94010
  • Mills Peninsula Medical Center-San Mateo, 100 S. San Mateo Dr., San Mateo, CA 94401
  • O’Connor Hospital, 2105 Forest Ave., San Jose, CA 95128
  • Regional Medical Center of San Jose, 225 N. Jackson Ave., San Jose, CA 95116
  • Santa Clara Valley Medical Center, 751 S. Bascom Ave., San Jose, CA 95128
  • Sequoia Hospital, 170 Alameda De Las Pulgas, Redwood City, CA 94062
  • St. Rose Hospital, 27200 Calaroga Ave., Hayward, CA 94545
  • UCSF Benioff Children’s Hospital-Oakland, 747 52nd St., Oakland, CA 94609
  • UCSF Benioff Children’s Hospital-San Francisco, 505 Parnassus Ave., San Francisco, CA 94143
  • Washington Hospital, 2000 Mowry Ave,, Fremont, CA 94538
 
Q: What about members who need emergency medical care from a Stanford hospital following the contract termination date?
 
A hospital’s emergency medical services are always considered a covered benefit 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 members to make informed decisions about when to use urgent care as opposed to emergency room care. Urgent care is usually appropriate when a member needs a physician’s attention for a condition that is non-life threatening. A member who needs urgent care should go to the nearest immediate or urgent care facility when his or her physician or network provider is unavailable.
 
Q: What do I need to do?
 
You may want to contact us regarding your care if you:
 
  • Are under treatment with any Stanford hospitals, facilities or healthcare providers after August 31, 2019;
  • Are scheduled for treatment at/with any Stanford hospitals, facilities or healthcare providers after August 31, 2019;
  • Have questions about your coverage; or
  • Need help accessing services in Anthem’s networks.
If any of these situations apply to you, please call the Member Services number on your Anthem ID card.