The Health Alliance hospitals – Christ, University, St. Luke, Jewish and Fort Hamilton – and the physicians of Alliance Primary Care want to make it possible for Anthem subscribers to use Health Alliance hospitals, even though we're currently not part of the network.

Here are some options:

Emergency care

When you have an emergency, you can come 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. Click here for a list of Anthem plans that have out of network benefits. Your out of network benefit allows you to go to hospitals and physicians that are not in the network for an additional cost. Our hospitals and Alliance Primary care will adjust the difference between the two benefits temporarily while we work with Anthem to negotiate a new contract. This means that if you have this benefit that you will pay no more to use a Health Alliance hospital or Alliance Primary Care physician than to use a hospital in the Anthem network. Once we receive the Anthem payment, we'll adjust the difference between Anthem's payment for the out-of-network benefit and your in-network benefit so that you will pay the same as for your in-network benefit.

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 insurance commission.
 

Anthem Senior Advantage. Unfortunately, Anthem does not offer an out-of-network benefit for Anthem Senior Advantage subscribers. However, you may want to consider the option of changing from Anthem Senior Advantage to traditional Medicare.

Anthem Senior Advantage (ASA) patients can still access Health Alliance hospitals and facilities by disenrolling from Anthem Senior Advantage. This automatically will re-enroll them in traditional Medicare and allow them to access Health Alliance hospitals. To disenroll from ASA, call 1-800-MEDICARE, select your language (English or Spanish), say "Yes" that you are calling about Medicare, say "No" that you are not calling about medical services, and say "Managed Care" during the next menu. You will be connected to a customer service representative who will assist you.

Traditional Medicare benefits are comparable to Anthem Senior Advantage benefits in most areas, and better in some respects. You should also know that you can change your enrollment every 30 days, so if you decide that Anthem Senior Advantage is better for you than traditional Medicare, you can re-enroll in Anthem Senior Advantage in 30 days.

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.

For more information about the contract, you can call us at 513-585-6464.