August 15, 2017
Anthem Blue Cross and MemorialCare Health System ("MemorialCare") have been engaged in negotiations and have been unable to reach reasonable contractual language and reimbursement rates that are beneficial to both organizations. Unfortunately, Anthem and MemorialCare were unable to reach agreement and the hospital contract terminated effective 12:00AM, August 15, 2017.
MemorialCare includes the following hospitals:
Members do not have to change doctors, the termination of contract is only for the hospitals listed above
This termination affects members who are enrolled in Commercial PPO, EPO, HMO, and POS benefit plans and receive care at MemorialCare hospitals. Members who have Medicare Part C are affected, however, those with a Medicare supplemental policy for Part A and Part B (Medigap), are not affected by this contract termination.
All non-emergency hospital services must be approved by the HMO member's participating medical group/IPA. If approved, Anthem Blue Cross will cover the claim at the member's in-network benefit levels. If not approved by the member's participating medical group/IPA, the claim will be denied, as stated in the members Evidence of Coverage (EOC).
Many doctors have admitting privileges at more than one hospital. Just because a member's doctor may have admitting privileges at MemorialCare does not necessarily mean that a doctor cannot treat his or her patients at another participating hospital.
Anthem Blue Cross does not share details of its confidential contract negotiations with the public. Negotiations often do work themselves out after the contract termination date, but that is not always the case. Anthem is working collaboratively with MemorialCare as well as the PPO physicians and medical groups that maintain admitting privileges to the hospital, to ensure a smooth transition for members.
For additional information, please contact your Burnham Benefits Consultant or Burnham Benefits at 949-833-2983 or email@example.com.
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