Anthem Blue Cross receives termination letter from HCA

On November 3, 2011, Anthem Blue Cross (“Anthem”) received a termination letter from Hospital Corporation of America (“HCA”) with an effective termination date of March 3, 2012.

Anthem and HCA have been engaged in commercial hospital contract negotiations for several months to reach agreement on reasonable reimbursement rates and contractual terms that are beneficial to both organizations. Unfortunately, to date, Anthem and HCA have been unable to reach an acceptable agreement and the commercial hospital contract may terminate effective 12:00am, March 3, 2012.

Anthem continues to negotiate in good faith with HCA in an effort to reach agreement before the expiration date.
Hospitals Affected
HCA includes the following hospitals:
Good Samaritan Hospital / Medicare ID 050380
Los Robles Regional Medical Center / Medicare ID 050549
Regional Medical Center of San Jose / Medicare ID 050125
Riverside Community Hospital / Medicare ID 050022
West Hills Hospital / Medicare ID 050481

How Members are Affected
What Anthem products are affected by this hospital termination?
This termination affects the out-of-pocket obligations for most Anthem members who are enrolled in PPO, HMO, POS, EPO, Senior Secure, Healthy Families EPO, AIM EPO, and MRMIP benefit plans and receive care at any of the HCA hospitals listed below.

Will members be notified about the contract termination?
As required by state law and regulations applicable to health care service plans licensed by the Department of Managed Health Care (DMHC), Anthem must mail letters to PPO members
enrolled in a DMHC-regulated health plan who reside within a 15-mile radius of a HCA hospital telling them about the termination.

Anthem will also mail letters to Healthy Families EPO, AIM EPO, and MRMIP members who reside within 15 miles of a HCA hospital. The letter instructs members to call the Customer Service number on their ID card if they are in a current course of treatment at one of the terminating hospitals or have questions or concerns about the contract termination.

How are Anthem HMO members affected by the HCA termination?
All non-emergency hospital services must be approved by the member’s participating medical group/IPA. If approved, Anthem 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).
Physicians, Medical Groups & Alternate Hospitals

What other participating Anthem network hospitals are available in HCA’s geographic area?
Anthem has a statewide hospital network of over 300 acute care facilities.
Find a Doctor can be used to locate a participating hospital in a specific area. The following is a partial list of alternate participating general acute care hospitals within the vicinity of each terminating HCA hospital:

Alternate Hospitals for Good Samaritan Hospital:
O’Connor Hospital, 2105 Forest Avenue, San Jose, CA 95128
El Camino Hospital, 2500 Grant Road, Mountain View, CA 94040
Santa Clara Valley Medical Center, 751 S. Bascom Avenue, San Jose, CA 95128
Stanford University Hospital, 300 Pasteur Drive, Palo Alto, CA 94305
Alternate Hospitals for Los Robles Regional Medical Center:
Providence Tarzana Medical Center, 18321 Clark Street, Tarzana, CA 91356
St. Johns Regional Medical Center, 1600 N. Rose Avenue, Oxnard, CA 93030
St. Johns Pleasant Valley Hospital, 2309 Antonio Avenue, Camarillo, CA 93010
Simi Valley Hospital, 2975 Sycamore Drive, Simi Valley, CA 93065
Alternate Hospitals for Regional Medical Center of San Jose:
El Camino Hospital, 2500 Grant Road, Mountain View, CA 94040
Santa Clara Valley Medical Center, 751 S. Bascom Avenue, San Jose, CA 95128
Washington Hospital, 2000 Mowry Avenue, Fremont, CA 94538
O’Connor Hospital, 2105 Forest Avenue, San Jose, CA 95128
Thousand Oaks Surgical Hospital, 401 Rolling Oaks Drive., Thousand Oaks, CA 91361Menlo Park Surgical Hospital, 570 Willow Road, Menlo Park, CA 94025
Alternate Hospitals for Riverside Community Hospital:
Community Hospital of San Bernardino, 1805 Medical Center Drive, San Bernardino, CA 92411
Corona Regional Medical Center, 800 S. Main Street, Corona, CA 92882
Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354
Parkview Community Hospital, 3865 Jackson Street, Riverside, CA 92503
Redlands Community Hospital, 350 Terracina Blvd., Redlands, CA 92373
St. Bernardine Medical Center, 2101 N. Waterman Avenue, San Bernardino, CA 92404
Vibra Specialty Hospital of San Bernardino, 1760 W. 16th Street, San Bernardino, CA 92411
Alternate Hospitals for West Hills Hospital:
Mission Community Hospital-Panorama Campus, 14850 Roscoe Blvd., Panorama City, CA 91402
Northridge Hospital Medical Center, 18300 Roscoe Blvd. Northridge, CA 91325
Pacifica Hospital of the Valley 9449 San Fernando Road, Sun Valley, CA 91352
Providence Holy Cross Medical Center, 15031 Rinaldi Street, Mission Hills, CA 91345
Providence Tarzana Medical Center, 18321 Clark Street, Tarzana, CA 91356
Simi Valley Hospital, 2975 Sycamore Drive, Simi Valley, CA 93065
Thousand Oaks Surgical Hospital, 401 Rolling Oaks Drive., Thousand Oaks, CA 91361
Valley Presbyterian Hospital, 15107 Vanowen Street, Van Nuys, CA 91409

Additional Member Information
How do members know if their doctor will be affected by this hospital termination?
Many doctors have admitting privileges at more than one hospital. Just because a member’s doctor may have admitting privileges at a HCA hospital does not necessarily mean that a doctor cannot still treat his or her patients at another Anthem participating hospital.
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Will Anthem Notify PPO physicians and admitting HMO medical groups about the contract termination?
On February 2, 2012, Anthem informed admitting medical groups and PPO physicians who maintain privileges/affiliations at a HCA hospital about the pending contract termination and included a list of alternate participating hospitals for them to direct Anthem members.

PPO physicians and HMO medical groups agreed in their contracts to admit members to participating Anthem hospitals to ensure that members receive the maximum benefit levels under their benefit agreement.

Will Anthem assist physicians in acquiring admitting privileges at an alternate hospital?
Anthem is ready and willing to assist our physician and medical group partners in acquiring admitting privileges at a participating hospital if necessary. In the event that a member’s physician cannot admit to an alternate hospital after a hospital contract termination, then Anthem will work with the physician or other healthcare professional to admit members to an in-network facility.

Post Termination Care
If a member is in-patient at a HCA hospital at 11:59 PM on March 2nd, 2012, the member will continue to receive uninterrupted care until he or she is discharged. In addition, the member’s in-network benefit levels
will apply for the entire in-patient stay.

Continuity of Care
California law provides for completion of covered services/continuity of care for certain medical conditions following a provider’s termination if, among other things, the provider and the plan agree on a rate of payment.

If the hospital agrees to the proposed rate, Anthem will provide completion of covered services/continuity of care in accordance with the law. Therefore, if a member began a course of treatment at a HCA hospital prior to the termination for one of the following conditions, the member or his/her physician can request continuity of care by calling Anthem’s Customer Service Department:

Members in an active course of treatment for an acute medical or behavioral health condition
Members in an active course of treatment for a serious chronic condition
Members who are pregnant, regardless of trimester
Members with a terminal illness
Members who are newborn children between the ages of birth and 36 months
Members with a surgery or other procedure that was authorized by Anthem or a delegated provider (HMO medical group) prior to the termination date and scheduled to occur within 180 days after the termination date.
Eligibility for continuity of care depends on factors outlined in the member’s EOC. Continuity of care/completion of covered-services will be considered by Anthem’s Transition Assistance Department on a case by case basis. When a case is approved, the claim(s) is/are processed at in-network benefit levels.

Please note: HMO members and physicians wishing to request continuity of care/completion of covered services would not contact Anthem because all medical management is delegated to the provider group. HMO members and physicians should contact their participating medical group.

Important: Anthem communications to PPO members enrolled in a DMHC-regulated health plan who reside within a 15-mile radius of a HCA hospital are legally required to contain the following message regarding completion of covered services/continuity of care: “If you have been receiving care from a health care provider, you may have a right to keep your provider for a designated time period. Please contact the Anthem Blue Cross customer service department, and if you have further questions, you are encouraged to contact the Department of Managed Health Care, which protects HMO/PPO 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.

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