NORTHSIDE HOSPITAL / ANTHEM CONTRACT DISPUTE

Published: Thu, 12/23/21

Please excuse this late notice, but many of you are concerned about the impact on your Anthem Medicare Supplement (Medigap) coverage given the ongoing negotiations with Northside Hospital and affiliates.

Those who are covered by original Medicare and an Anthem Medigap plan are NOT IMPACTED by this disagreement.

Some of the public announcements and private letters to patients refers to NETWORKS and CONTRACTS being cancelled.

Original Medicare does not have HMO or PPO provider networks.

Medicare supplement plans, which are secondary payers, likewise do not have HMO or PPO provider networks.

Medical providers DO NOT have contracts with Medigap carriers. Likewise, providers DO NOT file claims with Medigap carriers.

Patients with Medicare Advantage Plans May be Impacted

The only Medicare plans with networks are Advantage plans with PPO or HMO provider networks.

Only patients covered by a PPO or HMO plan MAY see a temporary disruption in access to care until the contract is successfully negotiated.

Media and Private Communication

Below are news excerpts and links concerning the falling-out . . .

decide whether to pay out of network cost to keep their Northside doctor

https://www.wsbtv.com/news/local/atlanta/patients-worried-anthem-northside-hospital-look-cut-ties-if-no-agreement-reached/AYGLT2TEVRGNNJK5J4SDXK767U/

we intend to reach a new agreement by the end of this year so we can keep its facilities and physicians in our network.

https://www.11alive.com/article/news/health/northside-hospital-anthem-blue-cross-blue-shield-negotiations/85-c404fe92-cedc-438c-bc69-769bf442334a

Northside told me as of December 31st, they would be out of network and would no longer be taking the insurance,

https://www.cbs46.com/investigations/born-with-half-a-heart-georgia-child-s-healthcare-in-limbo-as-hospital-insurer-negotiate/article_d84da6f4-5c35-11ec-9a62-073aac25b7ad.html

This email from a client includes a notice from a physician group affiliated with Northside Hospital.

Anthem has told us that they plan to terminate their contract with all Northside hospitals and physicians, including Laureate Medical Group, effective January 1, 2022

If you have concerns about Anthem's decision to remove Laureate from its networks . . .

Anthem Provider Relations Department is aware of communications from Northside affiliate providers and is in contact with Northside Hospital and affiliates. Northside patients need reassurance that any disruption in access to care only impacts them if they have an HMO or PPO plan.

Both sides are continuing negotiations in hope of settling their differences so HMO and PPO patients can maintain continuity of care.

Repeating . . . Anthem Medicare supplement plans do not contract with providers . . . Anthem Medicare supplement plans do not have networks.

Final Word . . .

Medical providers (hospitals, doctors, labs, etc) may refuse to accept specific Medicare supplement plans but ONLY IF they refuse Medigap plans from ALL insurance carriers. In other words, they cannot refuse to treat patients with Anthem Medigap plans unless they refuse care to patients with plans from ALL OTHER issuing carriers.

In other words, they are not allowed to pick and choose which insurance carriers they like and which they don’t like.

This protection is afforded you by CMS rules and regulations.

Patients with PPO or HMO plans do not have this protection.

You have the greatest access to health care when you have original Medicare and a supplement plan.

Please let me know if you have questions.

Merry Christmas,

Bob

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