Sonoma Valley Hospital and Anthem Blue Cross reach agreement.
Updated 4/4/2024
We are pleased to announce Sonoma Valley Hospital and Anthem Blue Cross (Anthem) have reached agreement on a 4-year contract that will allow our hospital to remain in Anthem’s provider network.
This means you may continue to make appointments, receive care and access services from Sonoma Valley Hospital with no changes or future disruptions. We are grateful that Anthem members in our community can now have peace of mind and can continue accessing Sonoma Valley Hospital.
Thank you to our community for their support during this process. Having the community’s support, voicing that support, really helps when the hospital faces these types of negotiations.
Thank you for trusting Sonoma Valley Hospital with your care.
Updated 3/28/2024
As of Monday, April 1, Sonoma Valley Hospital may no longer be in-network with Anthem. We remain resolute in our commitment to serve our community. Contact us to learn how this affects you – community@sonomavalleyhospital.org.
Updated 3/21/2024
Over the past several months, we’ve reached out to our valued patients, community partners, trusted employers, and our beloved community to let you know our current contract with Anthem Blue Cross is not sustainable. At Sonoma Valley Hospital, our first concern is always our patients. Should we go out-of-network on April 1, we will continue to negotiate with Anthem Blue Cross.
With unwavering commitment to serve our community, we strive for a solution. Our lines of communication are always open. Contact us at community@sonomavalleyhospital.org.
Updated February 29, 2024
We are pleased to announce both parties have agreed to extend the contract for another month, through March 31, 2024. We continue active discussions with Anthem Blue Cross in the hope of finding a solution quickly.
Thank you to our community who joined us at our virtual Town Hall on KSVY Wednesday evening. CEO John Hennelly and Revenue Cycle Manager Lisa Stone were able to answer many of your questions regarding our contract negotiations with Anthem Blue Cross. In case you missed it, you can find the recording here: Sonoma Valley Hospital Townhall Anthem Blue Cross – YouTube
During the Town Hall, we discussed the Anthem Continuity/Transition of Care Request Form. This request form can be filled out and returned to Anthem for their review. Please contact Anthem at the number on the back of your membership card with questions.
Updated February 22, 2024
Anthem Blue Cross is using its strength and size to demand unfair contractual arrangements for our services, even as it consistently raises member premiums and reports record profits for shareholders.
For nearly 80 years, our community has relied on Sonoma Valley Hospital to keep them and their families healthy. Every day we are hard at work to make care more accessible and affordable for everyone we serve.
To continue to serve as a reliable source for quality, convenient care, we need sustainable reimbursement from Anthem Blue Cross, the state’s largest health insurance company.
- If we are unable to reach a new agreement, Anthem will exclude Sonoma Valley Hospital from their network, and, outside of emergency services, our patients will not receive full coverage when they receive care at our hospital beginning March 1, 2024.
- At Sonoma Valley Hospital, our number one priority is the health of our community that depends on us for their care.
- As Sonoma Valley’s most vital health care resource, our hospital needs a fair agreement with Anthem to maintain the standard of care that our patients deserve.
- We remain willing to negotiate with Anthem in the hopes of securing new contract and will keep our patients informed of the progress of negotiations, the process to maintain continuity of their health care and anything else we can do to sustain their health.
Updated January 30, 2024 – The contract negotiations between Sonoma Valley Hospital and Anthem are still ongoing, with the existing contract set to expire on March 1st, 2024. Please be aware that the hospital’s emergency services are still ‘in-network’ for all insurance plans. You will only pay your plan’s cost-sharing amount (such as copayments, coinsurance, and deductibles) for any emergency care you receive at the hospital.
Updated January 4, 2024 – Anthem’s contract with Sonoma Valley Hospital remains in effect, now until March 1st, as both parties agreed to a 30-day extension due to time lost brought on by the holiday season. We hope for meaningful progress in January as the negotiations continue. Emergency services at the hospital are always available and ‘in-network’. Whether you have Anthem, Medicare, Kaiser, or any other insurance plan, the most the hospital will ever bill for emergency services are your plan’s cost-sharing amount (such as copayments, coinsurance, and deductibles).
Updated December 14, 2023: Did you know that evaluating our payer contracts to ensure fair and equitable rates for Sonoma Valley Hospital services is a normal course of business?
Many don’t think of hospitals as a business, but SVH pays bills just as any other business would. Staffing, supplies, building maintenance, utilities, all the costs any other business would pay.
As your community hospital, SVH must have rate increases that support overall expenses. Our current reimbursement that we receive from Anthem Blue Cross does not meet this need. We continue to negotiate. We’re hopeful that Anthem will recognize that a high-quality, low-cost provider is one they should want to keep in-network.
We are working hard to avoid a potential expiration of our agreement with Anthem. If we cannot agree to terms by February 1st, Sonoma Valley Hospital would be considered out of network with Anthem Blue Cross. If both parties cannot reach an agreement by 2/1/24, we will continue our good-faith negotiations in hopes of arriving at a contract. This does not mean that SVH is guaranteed to be out of network for an extended period of time, we will continue to prioritize negotiating in good faith. If SVH and Anthem can come to a consensus post-termination, SVH would then be back in-network for Anthem, effective immediately.
Updated December 7, 2023: Our hospital continues to negotiate with Anthem Blue Cross. We are focused on insuring that the reimbursement provided by the insurance company meets the cost the hospital spends to provide care to Anthem members. This cost includes wages, supplies, overhead (water, electricity, etc.) as well as a tiny fraction of the money we will need to reinvest in our building to insure we continue to have the tools necessary to provide care. This is the expectation we have for all of our insurance partners.
While we wish we could tell you when this will end, we are prioritizing the financial viability of our hospital and insisting that our insurance partners provide reasonable reimbursement. Contact us at community@sonomavalleyhospital.org with any questions.
The Facts
Sonoma Valley Hospital may be excluded from the Anthem Blue Cross network effective February 1, 2024. SVH has been in negotiations since June of this year.
We continue to negotiate an agreement with Anthem Blue Cross that would allow us to provide in-network care to Anthem Blue Cross members at Sonoma Valley Hospital. Unfortunately, Anthem Blue Cross has not accepted our proposals and our current contract is set to expire on February 1, 2024.
SVH and Anthem Blue Cross FAQConsider Switching Plans
If coverage at SVH is important to you, please explore other plans that include SVH in their network. You may have the option to switch your coverage during your employer’s Open Enrollment. A list of plans we participate in are below:
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
Putting Patients First
For nearly 80 years, our community has relied on SVH to keep them and their families healthy. Every day we are hard at work to make care more accessible and affordable for everyone we serve.
Yet, we face serious challenges. Healthcare providers across the country are experiencing the crushing weight of rapidly rising costs of care caused by inflation, labor shortages and reductions in funding.
Sonoma Valley Hospital is no exception.
To continue to serve as a reliable source for quality, convenient care, we need sustainable reimbursement from Anthem Blue Cross, the state’s largest health insurance company.
We know you may have questions or concerns about how our network status may impact your access to care with SVH. We’re here to help our community, whenever and wherever they need us.
For more information, please check our frequently asked questions (FAQ), or email us at community@sonomavalleyhospital.org. You may also call the Department of Managed Health Care (DMHC), which protects 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.
What You Can Do
You can advocate for your continued in-network access to Sonoma Valley Hospital.
Call Anthem Blue Cross
Using the number on the back of your insurance card, let Anthem Blue Cross know how vital it is to have in-network access to Sonoma Valley Hospital.
If you receive your insurance through your employer
Ask your HR or benefits manager about alternate or secondary coverage options that will protect your in-network access to Sonoma Valley Hospital.
If you buy insurance from the Health Insurance Exchange
Open Enrollment period starts November 1, 2023, and runs through January 14, 2024. To guarantee your continued in-network access to SVH, consider selecting a plan during Open Enrollment that includes SVH in its network.
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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