Frequently Asked Questions

Information for Anthem Blue Cross PPO Patients  Click here for a copy of this FAQ

 

Q:             Why is the Anthem Blue Cross agreement in jeopardy of termination?

A:          Anthem Blue Cross is a for profit health insurance plan.  While the cost of your insurance premium, paid for by your employer and/or you, continues to escalate and the cost of providing health care services continues to escalate, Anthem has not increased their contractual payment to Hazel Hawkins Memorial Hospital (HHMH) since 2018.  The current Anthem Blue Cross contracted payment does not sufficiently cover the cost of the healthcare services provided.         To date, Hazel Hawkins Memorial Hospital has not been able to secure adequate reimbursement, market rate, for the health care services provided to Anthem Blue Cross Preferred Provider Organization (PPO) Members.

 

Q:         Anthem Blue Cross is my health plan. How does the contract negotiation impact me?

A:          Negotiations between Anthem Blue Cross and Hazel Hawkins Memorial Hospital have been ongoing since 2020.  If an agreement cannot be reached by the current contract termination date at midnight on August 10, 2022, Hazel Hawkins Memorial Hospital and Health System, including outpatient services will be “out-of-network” for all patients with an Anthem Blue Cross Preferred Provider Organization (PPO) Health Plan and an Anthem Blue Cross Blue Cross Medicare plan.

 

Q:         How does “out of network” impact my access to healthcare services provided by Hazel Hawkins Memorial Hospital?

A:          If termination occurs, on or after August 11, 2022, Hazel Hawkins Memorial Hospital inpatient and outpatient services will no longer be contracted with Anthem Blue Cross PPO and Anthem Blue Cross Medicare This means you may no longer have in-network benefits with our hospital including inpatient and outpatient services, homecare, and skilled nursing.  You may continue to access our health care providers and Hospital for health care services as follows:

  • Emergency Care: Emergency care access is not impacted. You may continue to receive emergency care at our Emergency Department, regardless of our network status with Anthem Blue Cross.
  • Continuity of Care: Some patients may be eligible to receive “Continuity of Care” benefits from Anthem Blue Cross for a period of time. These patients often need ongoing care or treatment, are pending an obstetric delivery, or already have a procedure authorized and scheduled. For questions about ongoing care or your benefit coverage, please call the phone number listed on the back of your Anthem Blue Cross insurance card.
  • Out-Of-Network Care: You may still access our health care providers and Hospital for health care services if you have an out-of-network benefit. In some situations, depending on the type of service Anthem Blue Cross authorizes, in-network benefits may be available if alternative providers are not available in the service area. Please call the number listed on the back of your insurance card to discuss your specific in or out-of-network benefits with Anthem Blue Cross.

 

Q:         Will I have to pay more to receive care if Hazel Hawkins Memorial Hospital becomes an out-of-network provider?

A:          Please call Anthem Blue Cross Customer Service, (844)971-0117 or number listed on the back of your insurance card to discuss your specific in or out-of-network benefits with Anthem Blue Cross. Hazel Hawkins Memorial Hospital offers self-pay and prompt payment options.  Contact our Business Office to learn if these options are financially beneficial for you or your family, (831) 205-5710.

 

Q:         What if I have a medical appointment, plan on delivering my baby or elective procedure scheduled on or after August 11, 2022?

A:          We understand you may already have appointments scheduled on or after August 11, 2022.  If this is the case, you may qualify for Continuity of Care benefits. Contact Anthem Blue Cross Customer Service (844)971-0117, or using the phone number on the back of your health insurance card, to learn more about your Continuity of Care benefit coverage.

 

Q:         How long will Hazel Hawkins Memorial Hospital be an out-of-network provider?

A:          At this time, it is difficult to determine how long we may be out of network. We have kept the lines of communication open with Anthem Blue Cross. We recognize and value our relationship with our patients and remain open to discussions with Anthem Blue Cross toward a mutually beneficial agreement. Please feel free to contact Anthem directly, (844)971-0117 to express your concern about having to leave the community to access health care services.