Anthem Blue Cross and Blue Shield Contract Negotiations with The Christ Hospital: What Members Need to Know
March 10, 2023March 2023
The Christ Hospital Health Network (TCH) has notified Anthem Blue Cross and Blue Shield in Ohio that it intends to leave our care provider network. Unless an agreement can be reached, TCH hospitals, outpatient centers, and other facilities will leave our network on April 1, 2023, and Christ Hospital Medical Associates and urgent care centers will leave our network on May 1, 2023. We continue to work hard and in good faith to negotiate a new agreement to keep Christ Hospital and its physicians in our network.
As we near the end of the current contract, we understand that if TCH insists on very large cost increases for consumers, we will not be able to prevent them from leaving our network. Therefore, we’re recommending our members consider scheduling or re-scheduling elective procedures at one of the many other health systems in our network. If TCH does leave our members’ network, costs for Anthem members at TCH doctors and hospitals will go up dramatically. Please see below for more information about the many alternate healthcare providers in our network.
Additionally, TriHealth is a preferred provider in Anthem’s network and can accommodate immediate access to primary care and most specialty services. Members impacted by TCH’s decision to leave our network may call (513) 862-4444 to schedule appointment(s).
Why is this happening?
The negotiations center around our goal of maintaining equitable access to quality, affordable healthcare for our members, and to minimize increased healthcare costs for Ohio families already struggling with high inflation. We understand that Greater Cincinnati health systems – like other health systems and businesses across the country – are experiencing difficult labor shortages and economic challenges.
However, TCH wants to raise prices for our members by more than double the inflation rate. Cost increases of that magnitude would be an unacceptable financial burden for Greater Cincinnati consumers and their families, and for our community’s employers – many of whom directly pay their employees’ medical bills. Anthem has offered TCH reasonable increases that are in line with those accepted by other healthcare systems in Ohio.
Will you reach an agreement?
We hope so. Anthem will continue to work in good faith to reach a new contract. However, because we are nearing the end of our current contact, we are recommending that our members consider scheduling or re-scheduling elective care at alternate in-network providers.
Please continue to check this site for updates.
What if I’m currently being treated at TCH?
We know this is especially concerning for our members currently receiving care at TCH. That’s why we’re taking steps to help in the event TCH leaves our network.
Under our proactive Continuity of Care (CoC) process, if you have received care 3 or more times in the last 6 months from the same TCH provider for certain conditions, Anthem will automatically extend your in-network benefits for care specific to that condition with that TCH provider for up to 90 days after TCH leaves our network. Members meeting these criteria for conditions including pregnancy, cancer, chronic conditions, behavioral health conditions, and end stage renal disease will receive a letter from Anthem explaining this process. Please see the frequently asked questions below for additional steps we’re taking for members in the 2nd or 3rd trimester of pregnancy or who meet the definition of terminally ill.
Even if you don’t meet the above proactive CoC criteria, you may be able to continue your care at TCH for a limited time after they leave our network if you are receiving certain types of care. Under federal law, this includes care if you are:
- In treatment for a serious and complex condition. This can be a sudden (acute) illness that requires specialized treatment to avoid death or permanent harm. It can also be an ongoing (chronic) illness that is life threatening or potentially disabling and requires specialized care over a long period of time.
- In a hospital or other inpatient facility.
- Scheduled for nonelective surgery by your current doctor, including your post-operative care for the surgery.
- Pregnant.
- Terminally ill.
In addition to federal law, your plan may allow you to stay with these hospitals for a limited time if you’re receiving certain other types of care. Please review your plan documents for information about Continuity of Care. You can find them by logging in to anthem.com. Under My Plan, go to your medical benefits page. You or your doctor may also submit a request for Continuity of Care by contacting our member service center at the number on your ID card or by submitting a Continuity of Care Request Form.
Frequently Asked Questions
Q: Who will be impacted if TCH leaves Anthem's plans?
If TCH chooses to leave Anthem’s network, all Anthem members receiving healthcare services from TCH doctors, hospitals and other care locations will be affected, including those in individual, employer-sponsored, Medicaid and Medicare Advantage plans.
If TCH chooses to leave Anthem’s network, all Anthem members receiving healthcare services from TCH doctors, hospitals and other care locations will be affected, including those in individual, employer-sponsored, Medicaid and Medicare Advantage plans.
Using out of network facilities and physicians will lead to higher costs for members, which is why we always encourage members to seek care from in-network providers.
Q: What TCH facilities and physician groups will be out of network if a new agreement is not reached?
All Christ Hospital facilities will no longer be a part of Anthem’s network effective April 1, 2023 if a new contract can’t be reached, including:
All Christ Hospital facilities will no longer be a part of Anthem’s network effective April 1, 2023 if a new contract can’t be reached, including:
- The Christ Hospital (Mt. Auburn)
- The Christ Hospital Medical Center (Liberty Township)
- Outpatient and surgery centers
- Imaging centers and laboratories
- Sleep centers
The Christ Hospital Medical Associates and urgent care locations will no longer be a part of Anthem’s network effective May 1, 2023, if a new contract can’t be reached.
Q: Where can I go for care if TCH leaves Anthem’s network?
Anthem offers a broad network of hospitals and physicians that includes every other health system in the Tri-State on most plans.
Anthem offers a broad network of hospitals and physicians that includes every other health system in the Tri-State on most plans.
TriHealth has opened a special appointment hotline and preferred scheduling appointments for Anthem members impacted by TCH’s decision to leave Anthem’s network. Members may call (513) 862-4444 for assistance transferring care quickly.
Members can use the Sydney Health mobile app or anthem.com from anywhere in the country to find in-network doctors near them. Members can also contact Anthem Member Services through Sydney Health or by calling the number on their Anthem ID Card.
Q: What if I am currently receiving care or undergoing a course of treatment at TCH for:
Pregnancy?
- Members in their 2nd and 3rd trimesters will receive in-network benefits under the terms of their benefit plan for care at TCH directly related to the member’s delivery through post-partum care.
- Members in their 1st trimester who meet the proactive CoC criteria above, will be extended in-network benefits for pregnancy-related services at TCH under the terms of their benefit plan for up to 90 days.
- Those who do not meet the proactive CoC criteria may submit a request for Continuity of Care by contacting our member service center or by submitting a Continuity of Care Request Form. They may also transfer care to an in-network provider.
Cancer (including radiation and chemotherapy treatment?
- Most members undergoing a course of cancer treatment will fall under the proactive CoC provision above and will automatically receive in-network benefits to continue cancer treatment under the terms of their benefit plan for up to 90 days post termination.
- Members who do not meet the proactive CoC criteria may submit a request for Continuity of Care by contacting our member service center or by submitting a Continuity of Care Request Form. Their doctors may also request CoC.
Terminal Illness?
- Members who are terminally ill as defined by the Social Security Act (6 months or less to live), will receive in-network benefits through the end of life.
Behavioral Health and Mental Issues?
- Most members with serious and complex conditions receiving outpatient behavioral health and mental health treatment will fall under the proactive CoC provision above and will automatically receive in-network benefits for care related to their condition under the terms of their benefit plan for up to 90 days after TCH leaves Anthem’s network.
- Members who do not meet the proactive CoC criteria may submit a request for Continuity of Care by contacting our member service center or by submitting a Continuity of Care Request Form. Their doctors may also request CoC.
Post-surgical therapy or aftercare?
- Most members who have surgery before TCH leaves Anthem’s network and are receiving postoperative care will fall under the proactive CoC provision above and will automatically receive in-network benefits under the terms of their benefit plan for up to 90 days after TCH leaves Anthem’s network.
- Members who do not meet the proactive CoC criteria may submit a request for Continuity of Care by contacting our member service center or by submitting a Continuity of Care Request Form. Their doctors may also request CoC.
End Stage Renal Disease?
- Most members will fall under the Proactive CoC provision above and will automatically receive in-network benefits under the terms of their benefit plan for up to 90 days after TCH leaves Anthem’s network to continue ESRD treatment.
- Members who do not meet the proactive CoC criteria may submit a request for Continuity of Care by contacting our member service center or by submitting a Continuity of Care Request Form. Their doctors may also request CoC.
Q: What should I do if I have an elective surgery scheduled after the termination date?
- We recommend our members reschedule elective surgeries at one of the many other health systems in our network.
- Members or their doctors may also submit a request for Continuity of Care by contacting our member service center or by submitting a Continuity of Care Request Form.
- Anthem will contact members with elective procedures scheduled after the termination date to explain the cost implications of moving forward with treatment at TCH and assist in transitioning care to an in-network provider if the member chooses to do so.
Q: Christ Hospital and Anthem have worked together for a long time. What changed?
That’s correct. We’re proud of the decades-long collaborative relationship we’ve had with TCH as we’ve worked together to serve Greater Cincinnati. Unfortunately, TCH informed Anthem it will leave our members’ network unless we agree to dramatic cost increases that would put substantial financial pressure on the people and businesses we serve. This could impact healthcare affordability for many in the area, which is why we continue to negotiate in good faith with TCH to keep healthcare affordable.
That’s correct. We’re proud of the decades-long collaborative relationship we’ve had with TCH as we’ve worked together to serve Greater Cincinnati. Unfortunately, TCH informed Anthem it will leave our members’ network unless we agree to dramatic cost increases that would put substantial financial pressure on the people and businesses we serve. This could impact healthcare affordability for many in the area, which is why we continue to negotiate in good faith with TCH to keep healthcare affordable.
Until we can agree to a new contract that ensures quality and protects affordability, we recommend our members consider scheduling or re-scheduling any elective procedures at alternate in-network facilities.
Q: What should I do if I need emergency medical care from TCH?
It is important to remember that TCH hospitals and facilities will remain in Anthem’s network until at least April 1, 2023, and Christ Hospital Medical Associates and urgent care centers remains in Anthem’s network until at least May 1, 2023. Even if they leave our network, a hospital’s emergency medical services do not require pre-authorization, regardless of where they are delivered. 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 policy benefits and in-network cost shares.
It is important to remember that TCH hospitals and facilities will remain in Anthem’s network until at least April 1, 2023, and Christ Hospital Medical Associates and urgent care centers remains in Anthem’s network until at least May 1, 2023. Even if they leave our network, a hospital’s emergency medical services do not require pre-authorization, regardless of where they are delivered. 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 policy benefits and in-network cost shares.
Q: What if I have further questions?
Please check this site for updates regarding our efforts to reach agreement with TCH. Anthem members can also call Member Services through the Sydney Health app or by calling the number on the back of their ID card.
Please check this site for updates regarding our efforts to reach agreement with TCH. Anthem members can also call Member Services through the Sydney Health app or by calling the number on the back of their ID card.
