Anthem Frequently Asked Questions
November 20, 2023Leer en español
- Q: What is happening between Sonoma Valley Hospital and Anthem Blue Cross?
A: Sonoma Valley Hospital is in active negotiations with Anthem Blue Cross and has been since June 2023. Our goal is to reach an agreement that would allow us to continue providing services as an in-network provider to Anthem Blue Cross members. We are working diligently to secure sustainable reimbursement to counter rapidly rising costs of care. - Q: Why haven’t you been able to come to a resolution with Anthem Blue Cross?
A: To continue to serve as a reliable source for high-quality, convenient care for our community, we need sustainable reimbursement from Anthem Blue Cross and other health insurance companies. Healthcare providers across the country are experiencing the crushing weight of rising costs and inflation.
We need Anthem to put the health of our community first, just as we are, by providing reimbursement rates that ensure we can continue to be there for our patients whenever and wherever they need us. - Q: Which Anthem Blue Cross health plans are affected by an Anthem Blue Cross termination?
A: All Anthem Blue Cross health plans (including but not limited to Anthem PPO, Anthem HMO, Anthem Medicare Advantage) would be affected. - Q: What is the difference between in-network and out-of-network?
A: “In-network” means Sonoma Valley Hospital has an existing contract with Anthem Blue Cross to see patients at a contracted rate for services. “Out-of-network” means Sonoma Valley Hospital does not have a contract with Anthem Blue Cross. - Q: What if I have a procedure scheduled at Sonoma Valley Hospital? Should I cancel that and any other upcoming appointments?
A: If you have a procedure that is currently scheduled, no, you do not need to cancel as that will be considered in-network even if it is scheduled to be performed after February 1st, 2024. - Q: Should I change my physician?
A: You do not need to change your physician. - Q: Can I still use Sonoma Valley Hospital’s Emergency Department?
A: Yes. By law, patients always have access to our emergency department, regardless of our contract status with Anthem Blue Cross. If you experience an emergency, you should visit the nearest emergency department. - Q: How long could Anthem Blue Cross patients be out of network if SVH’s contract is terminated effective February 1, 2024?
A: Unfortunately, there is no timeline for a successful renegotiation with Anthem Blue Cross. We intend to continue negotiating in good faith for a fair and equitable agreement that keeps Sonoma Valley Hospital in-network and accessible for Anthem Blue Cross members. We will be transparent and keep our community updated throughout the negotiations. - Q: How can I stay up-to-date on the negotiations?
A: As our negotiations with Anthem Blue Cross progress, we will continue to keep our patients informed through regular communication:
Website: sonomavalleyhospital.org/svhblueanthem
You may send an email question to community@sonomavalleyhospital.org - Q: What can I do to ensure I have continued in-network access to Sonoma Valley Hospital?
A: Contact Anthem today. Email Beth Andersen, President, California Commercial Business/Anthem, beth.andersen@anthem.com and urge Anthem to work with us to protect your in-network access to Sonoma Valley Hospital.
a. Contact your broker. If you acquired your plan through a broker, ask them about coverage options that will allow you to maintain in-network access to SVH.
b. Speak with your HR or benefits manager at work. If you receive coverage through your employer, ask your HR or benefits manager about alternate or secondary coverage options that will protect your in-network access to SVH.
c. Select a new plan during the upcoming open enrollment period: If you purchase your own insurance from the Health Insurance Exchange, you can select a new plan during California’s upcoming open enrollment period to guarantee your in-network access to SVH. We are in-network with the following exchange plans for the full 2023/4 benefit year:
HMO
Meritage Medical Network (ALL HMO’s offering Meritage for their medical group)
PPO
Aetna
Blue Shield of California, PPO
Cigna
Community Health Plan (CHP)
First Health
Health Net
Health Smart/InterPlan
Humana Choice Care
Multiplan
Pacific Health Alliance (PHA)
Private Healthcare Systems, Inc. (PHCS)
TRPN – Three Rivers Provider Network
United Healthcare
Western Growers – Pinnacle Claims Management - Q: What are Continuity of Care Services?
A: Certain patients, including those who are hospitalized, pregnant or undergoing an active course of treatment prior to the contract expiration date may qualify for Continuity of Care services through Anthem Blue Cross. - Q: What if I am pregnant or receiving treatment for a special condition?
A: Certain patients, including those who are hospitalized, pregnant or undergoing an active course of treatment, including outpatient oncology infusion services prior to the contract end date, may qualify for Continuity of Care through Anthem Blue Cross. If you think you may qualify, fill out this Continuity of Care form, and send to Anthem Blue Cross. - Q: What are some examples of services that may be eligible for coverage under Anthem Blue Cross Continuity of Care program?
A: Examples of conditions that may qualify for Continuity of Care services include those listed below.
| Type of problem: | How long you get continuity of care: |
| Acute condition (for example, pneumonia) | As long as the condition lasts |
| Serious chronic condition (for example, severe diabetes or heart disease) | No more than 12 months. Usually until you complete a period of treatment and your doctor can safely transfer your care to another doctor |
| Terminal illness | As long as the person lives |
| Care of a child under 3 years | For up to 12 months |
| An already scheduled surgery or other procedure (for example, knee surgery or colonoscopy) | The surgery or procedure must be scheduled to happen within 180 days of your doctor or hospital leaving your health plan |
*Source: California Department of Managed Healthcare hhps://www.dmhc.ca.gov/HealthCareinCalifornia/YourHealthCareRights/ConLnuityofCare.aspx
- Q: How do I apply for Continuity of Care Services?
A: Your provider’s office will have a Continuity of Care form available for you to fill out and send to Anthem Blue Cross. Please note, the Continuity of Care form is also available on our website at sonomavalleyhospital.org/svhblueanthem
Contact Us Anytime
Have Questions? Email us anytime.
We know you may have questions or concerns about how our network status may impact your access to care. We’re here to help.
Please email Lisa Stone (community@sonomavalleyhospital.org) anytime with questions.
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