Update on Your Health Plan’s Network: Sutter HealthFebruary 01, 2019
Important Information: Anthem Blue Cross negotiations with Sutter Health
Anthem Blue Cross of California (Anthem) is actively engaged in negotiations in an effort to reach a new agreement with Sutter Health (Sutter) so that its facilities and physicians will be in our care provider network for all of our consumers. Although the Sutter and Anthem agreement terminated on December 31, 2018, that agreement allows for negotiations on a new contract to continue and for the time being, Anthem will continue to offer in-network benefits to members who continue to see Sutter providers.
However, while we continue to negotiate in good faith, state regulations require us to notify our consumers covered by HMO health plans 60 days in advance of any changes made to their assigned physician/medical group. To comply with our regulatory requirements, we have sent letters to our consumers with HMO plans who are assigned to a Sutter physician notifying them that they will be transitioned to another primary care physician effective April 1, 2019, in the event that a new agreement is not reached by that date.
We understand reliable access to quality health care, in addition to affordability, is of utmost importance to all of our consumers, which is why we continue to negotiate with Sutter in an effort to reach a new agreement before April 1. Anthem does have a broad network of providers throughout the state, and we will continue to have quality healthcare alternatives for our members in the unfortunate event we do not come to an agreement with Sutter.
Our top priority during these negotiations is to protect consumers’ access to affordable healthcare. It is our sincere desire to reach an agreement with Sutter that would protect affordability for our consumers, while providing expanded flexibility and network options, making healthcare more accessible and simpler for consumers. The many businesses and consumers we serve in California trust us to deliver access to high quality health care that is affordable. We value their trust in us and we take our responsibility very seriously.
Why is this Happening?
Contract discussions are a standard, normal and routine part of what we do. As we negotiate with providers, we try to strike a balance between protecting affordability and providing a broad network of providers to create choices for our consumers. We are seeking to reach an agreement with Sutter that would help us achieve these goals.
We are actively negotiating in good faith with Sutter. Seeing as these negotiations have extended beyond the contract termination date it is important we start the process of transitioning consumers with HMO health plans to other physicians to help limit any potential disruptions.
While we are working hard to reach a fair agreement with Sutter, it is important to understand consumers with HMO health plans will be transitioned to non-Sutter physicians if a new agreement is not reached by April 1, 2019. You may want to reach out to your doctor and share your concerns. It is our sincere hope we can reach an agreement before this occurs.
Continuity of Care
For HMO members of Sutter Health Medical Groups wishing to request continuity of care should contact Anthem. If an Anthem Blue Cross member began a course of treatment with Sutter Health 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 January 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.
Frequently Asked Questions
Q: How can I stay up-to-date on Sutter's status?
For the most up-to-date information refer to this site at anthem.com/ca/sutter] or call the Member Services number on your Anthem Blue Cross member ID card. This site will be updated as information becomes available.
Q: Does this impact all Anthem members?
Yes, but on different timelines. As of February 1, 2019, Anthem Medi-Cal members assigned to a Sutter physician will be transitioned to another provider in the area. Medi-Cal members can work with their care provider and our customer service team by calling the number on the back of the Anthem Blue Cross card to request a continuity of care plan. Those with commercial HMO plans assigned to Sutter physicians will be assigned to another primary care physician effective April 1. These consumers will continue to have in-network access to Sutter facilities and doctors for the time being.
Q: What will the direct impact be to HMO plan consumers, if an agreement isn’t reached soon?
HMO consumers will be transitioned to a non-Sutter primary care physician effective April 1. We are notifying those members 60 days in advance of that date in accordance with state regulations. It is important to note these consumers can continue to utilize Sutter physicians and facilities at the in-network benefit level for the time being. Those members who are receiving ongoing care at Sutter should work with their care provider and our customer service team by calling the number on the back of the Anthem Blue Cross ID card to request a continuity of care plan.
Q: What Sutter facilities and medical groups are affected by these ongoing negotiations?
- Alta Bates Summit MC – Alta Bates
- Alta Bates Summit MC – Summit Campus
- California Pacific Medical Center – California
- California Pacific Medical Center – Davies
- California Pacific Medical Center – Pacific
- California Pacific Medical Center – St. Lukes
- Eden Medical Center
- Memorial Hospital Los Banos
- Memorial Hospital Medical Center – Modesto
- Menlo Park Surgical Hospital
- Mills Health Center
- Mills-Peninsula Hospital & Medical Center
- Novato Community Hospital
- Palo Alto Foundation Santa Cruz Site
- Palo Alto Medical Foundation
- Palo Alto Medical Foundation/Camino Site
- Palo Alto Medical Foundation/Mills Peninsula
- Peninsula Medical Clinic
- Stanislaus Surgical Hospital
- Sutter Amador Hospital
- Sutter Auburn Faith Hospital
- Sutter Coast Hospital
- Sutter Davis Hospital
- Sutter Delta Medical Center
- Sutter East Bay Medical Foundation
- Sutter East Bay Medical Foundation/SEBMF- Diablo Division
- Sutter Gould Medical Foundation
- Sutter Independent Physicians
- Sutter Lakeside Hospital
- Sutter Maternity & Surgery Ctr of Santa Cruz
- Sutter Medical Center, Sacramento
- Sutter Medical Group – Yolo Division
- Sutter Medical Group Solano Div
- Sutter Medical Group-Sacramento/Placer Division
- Sutter Pacific Medical Foundation
- Sutter Roseville Medical Center
- Sutter Santa Rosa Regional Hospital
- Sutter Solano Medical Center
- Sutter Surgical Hospital – North Valley
- Sutter Tracy Community Hospital
Q: I want to avoid out-of-network charges. Who else can I see for care? What are the alternative in-network care providers available to me?
It is important to note, consumers with employer-based or individual health plans can continue to have in-network access to Sutter facilities and doctors for the time being.
In the event a new agreement cannot be reached with Sutter, Anthem offers a broad network of choices in healthcare. 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 other participating Anthem network hospitals are available in the vicinity of the Sutter Hospitals?
Again, it is important to note, consumers with employer-based or individual health plans can continue to have in-network access to Sutter facilities and doctors for the time being.
Anthem does have a broad, statewide hospital network of more than 300 acute care facilities. The Find a Doctor feature available on www.anthem.com/ca can be used to locate a participating hospital in a specific area. Customer Service representatives can also check the provider database for a physician’s admitting privileges at another nearby in-network facility. Members should confirm the information they receive with their treating physician. Every effort will be made to assist members in determining their choices and understanding the potential financial consequences of seeking care with a provider that is not in the Anthem Blue Cross provider network.
Q: What about members who need emergency medical care from a Sutter hospital following the contract termination date?
A hospital’s 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 members to make informed decisions about when to use urgent care as opposed to emergency room care. Urgent care is 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 don’t need to do anything at the moment unless you:
- Are under treatment with any of these hospitals, facilities or health care providers after April 1, 2019;
- Are scheduled for treatment at/with any of these hospitals, facilities or health care providers after April 1, 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.
Please note: If you have been receiving care from a health care provider, you may have a right to keep your provider for a designated time period. Please contact your HMO's customer service department, and if you have further questions, you are encouraged to contact the Department of Managed Health Care, which protects HMO consumers, by telephone at its toll-free number, 1-888-HMO-2219, or at a TDD number for the hearing impaired at 1-877-688-9891, or online at www.hmohelp.ca.gov.