For more Information:
513-585-7600

Status of the Health Alliance and Anthem Negotiations

Because The Health Alliance is in a period of transition, we have simply asked Anthem to renew our current contract for one year, until the future of Alliance hospitals and physicians can be secured.  We are negotiating in good faith, and will continue to pursue a fair and reasonable agreement without disruption.

Anthem, however, has proposed a contract that attempts to take advantage of and profit from the uncertainty surrounding the Health Alliance, negatively impacting Anthem members, the hospitals and physicians providing their care, and seriously impairing University Hospital’s unique “safety net” role of caring for the sickest, poorest and most injured patients in this community.

Specifically, Anthem’s proposal is:

Unfair and unreasonable.  Anthem’s proposal provides a payment decrease, including a significant reduction for treating the sickest patients and for emergency care.  This threatens the Alliance’s mission to provide the highest quality care and to care for the poorest and sickest patients in this region.

Inaccurate and incomplete.  Anthem has yet to provide detailed rate proposals for some Alliance facilities, and much of the information they have provided is wrong, or incomplete.  Anthem is also looking to change the way we are paid for more than half of our services with no assurances of their ability to administer their proposed new payment methods. 

Heavy-handed and lacks transparency. Anthem refuses to disclose important information and wants the right to change its agreements without the Alliance’s prior review or agreement!  Further, Anthem won't agree to determine which procedures are medically necessary, using industry standards.  Often they are late to adopt procedures that have proved helpful to patients.

ANTHEM PATIENTS:

• Emergency Care:

If you have an emergency, you may go to any hospital, including Health Alliance hospitals, whether or not that hospital is part of the Anthem network.

• Out-of-Network Benefits

Many Anthem plans have an out-of-network benefit. About 80 percent of Anthem subscribers have this benefit. Your out of network benefit allows you to go to hospitals and physicians that are not in the network for an additional cost.  Should you need our services, we will work with you to make payment arrangements that you can afford.

Anthem’s insurance contracts require them to allow patients to use this out-of-network benefit. If for any reason your request to do so is denied, you should protest this to Anthem, your employer or the state  Department of Insurance.

• Plans Without an Out-Of-Network Benefit

Anthem HMO plans and other plans without an out-of-network benefit. To keep using Alliance hospitals and Alliance Primary Care physicians, ask your employer if it’s possible to change plans, since there has been a change in the network. Remember also, that emergency care is covered, whether or not the Health Alliance hospitals are in the network.

FAQ’S:

1. How is this going to affect me the patient?

If Anthem and the Health Alliance don’t sign a contract by March 31, 2010, you will lose access to Health Alliance hospitals and physicians at in-network rates, effective April 1, 2010.

2. If you don’t reach a deal by March 31st, will you continue to negotiate, i.e., is this temporary or permanent for me?

Negotiations will continue until an agreement is reached.

3. If I have current claims that haven’t been processed, will they be covered at an in-network rate?

If the contract expires, claims for dates of service prior to midnight on 3/31/10 will be processed at in-network rates.

4. What is the window for my physician to file claims in network?

If the contract expires, claims for dates of service submitted prior to midnight on 3/31/10 will be processed at in-network rates regardless of when the claim is submitted.

5. Can my physicians’ group negotiate a contract with Anthem if the Health Alliance and Anthem don’t reach an agreement?

No.  Your Alliance Primary Care doctor is a member of the Health Alliance and comes under the Health Alliance's contract with Anthem.

6. What if I go to a specialist and there is no other specialist in this area? Will this be covered at an in network rate or a negotiated rate?

Your health plan must provide in-network services if you see an out-of-network doctor because the Anthem network does not include a doctor of the type you need to see.

7. Have the HA and Anthem been in this situation before? What was the outcome?

Yes and an agreement was reached.

8. Is this long, drawn-out negotiation just typical insurance behavior?

While it is not unusual for health care insurers, such as Anthem, and health providers, such as the Health Alliance, to deadlock on negotiations—resulting in periods when patients are out-of-network,-- it is never a desirable situation for patients or health care providers.

9. Will national health care reform have any impact on these negotiations?

 No. Even if some form of health care reform should eventually pass, many of the measures would not take effect for years.

STAY INFORMED:

Negotiation Updates:
We will update the status section above as new information becomes available, so check back with us.

HOW CAN YOU HELP?

Interested in contacting Anthem and urging them to negotiate in the best interests of their members, Health Alliance hospitals and physicians and the community?

CONTACT INFORMATION
Need more information?
If you need more information, please call us at 513-585-7600, or email us at AnthemNegotiations.

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