Enloe Medical Center has extended its contract with Anthem through midnight on May 10, 2019Newsletter sent September 11, 2018
Newsletter sent October 1, 2018 BSSP letter to Enloe sent October 15, 2018 Newsletter sent October 15, 2018 Newsletter sent October 22, 2018 Newsletter sent October 29, 2018 CalPERS letter to Enloe sent October 31, 2018 Newsletter sent November 1, 2018 Newsletter sent November 6, 2018 Information on hospital prices and SISC premiums Newsletter sent December 6, 2018 BSSP letter to Enloe sent December 17, 2018 Newsletter sent December 31, 2018 What is the status of Anthem and Enloe negotiations? Enloe Medical Center has extended its contract with Anthem through midnight on May 10, 2019. What's next? We are hopeful that Anthem and Enloe will continue to negotiate towards a fair and reasonable contract with Enloe as a network network provider.
If Enloe Medical Center and Anthem Blue Cross do not come to an agreement by midnight on May 10, 2019, Continuity of Care would begin May 10, 2019, and extend six months thereafter. If the contract does terminate and you need additional care, please call Member Services/Coastal at (800-564-7475), and they will assess your current health status and plan of care at that time. REMINDER: You are eligible to apply for Continuity of Care at any point during the 180 day period after the contract termination. However, if you have scheduled procedures, treatments, etc. immediately following the current extension date, it is best to start the application process prior to the expiration of the extension on May 10, 2019. Contact Member Services/Coastal (800-564-7475) immediately to discuss continuity of care options if you are an Enloe patient and:
Due to the volume of members impacted (remember, this is all of Anthem --- not just BSSP) by Enloe's termination, response time to request for Continuity of Care may be delayed. Please be assured Anthem’s Continuity of Care team is working diligently to prioritize requests and members should expect a response within 48-hours prior to a procedure or visit. There is a great deal of complexity that varies case by case, and some members will receive a response more quickly than others. Note that Enloe must also agree to the Continuity of Care provisions on a case-by-case basis. There is no mandate to seek care at Enloe, although in many cases there are no alternatives for care within Chico. Your BSSP+SISC coverage is available with any Anthem network provider, including Oroville Hospital, practices affiliated with the organization, and other independent practices and facilities. Only Enloe Medical Center and its practices are impacted by the notice of termination. The Anthem online provider search tool may still list Enloe providers and facilities as "in-network" today. Anthem is working to update the website. When searching for alternative providers in your area, be sure to ask if they accept Anthem Blue Cross Large Group PPO insurance when calling the office/facility. See more FAQ's on the box on the right side of this page. Remember! Any increase in the Anthem/Enloe rates as a result of these negotiations will have a direct increase on members' out of pocket costs and premium rates. |
Frequently Asked QuestionsWhat can I do to help Anthem and Enloe reach a resolution?
BSSP has expressed to Enloe Medical Center the urgent need for a fair and reasonable resolution to the Anthem contract. Here's a copy of the BSSP letter. BSSP also met with Enloe representatives on Monday, October 29th to reiterate the need for resolution or, at a minimum, an extension.
You are encouraged to share your concerns with your Enloe physician. Additionally, you may reach out to Enloe Medical Center to share your concerns as well via email at mike.wiltermood@enloe.org and BoardOfTrustees@enloe.org. Below is sample content which you may copy, paste and edit, particularly those areas in [bracketed red text], as you feel appropriate: Dear Mr. Wiltermood and Trustees, It is my understanding that Enloe terminated its contract with Anthem effective November 1, 2018 and that Enloe has proposed a new contract which contains rate increases of more than 40% on some charges over the proposed 3-year term. As resident of the Chico community [or Butte County] and patient of Enloe Medical Center [and/or Enloe's OB-GYN Associates, Cardiology Services (or whatever Enloe specialty practice you see)], I urge you to resolve the contract with Anthem immediately and retroactive to November 1 at a fair and reasonable rate increase which is well below the proposed 40%. At the minimum, do what other health systems have done to relieve anxiety, confusion and disruption to your patients ... extend the expired contract while negotiations with Anthem continue. The cost of healthcare is already unaffordable. Enloe's requested increases are not sustainable. As a community member covered under a self-funded plan, my monthly premiums will be significantly impacted as claim costs increase under the contract. Additionally, I will pay 100% of the rate increases directly for those claims applying to my deductible. A substantial portion of your patients are covered under self-funded plans through Butte Schools Self-Funded Programs (K-12 schools, Butte County Office of Education and Butte-Glenn Community College District totaling 8700 Butte County residents), California's Valued Trust (some employees of Paradise Unified School District and Oroville Union High School District as well as employees of Thermalito Union Elementary School District) and CalPERS (state employees and those of the County of Butte, California State University, Chico and other municipalities within Butte and neighboring counties). Your increased rates will be passed on directly as increased premiums and out of pocket costs to everyone covered by these self-funded plans. I have previously received high quality care at Enloe and would like to continue being an Enloe patient. I also appreciate Enloe's community outreach efforts. As a result of your termination with Anthem, I am forced to seek care from other Anthem network facilities and practices within Chico and neighboring communities as I cannot afford to seek care from non-network providers. On behalf of all patients and community members covered under Anthem's commercial contracts, I urge you to resolve contract negotiations immediately. Sincerely, What if I am in-patient at Enloe Medical Center on the date of termination?
If you were in-patient at 11:59 PM on the date of termination or expiration, then you will continue to receive uninterrupted care at Enloe Medical Center until you are discharged. In addition, your in-network benefit levels will apply for the entire in-patient stay.
What if I need to complete a course of treatment (continuity of care) at Enloe Medical Center after the contract termination date?
If you began a course of treatment at Enloe Medical Center before November 1 for one of the following conditions, your or your physician can request continuity of care by calling Customer Service/Coastal at 800-564-7475. Be sure to ask to speak with a Continuity of Care representative and inform them you would like to complete the necessary paperwork via phone.
Continuity of care applies to:
Due to the volume of members impacted (remember, this is all of Anthem --- not just BSSP) by Enloe's termination, response time may be 7-10 days from submission of paperwork and up to 48-hours prior to a procedure or visit. Note that Enloe must also agree to the continuity of care provisions on a case-by-case basis. What if I do not qualify for completion of covered services / continuity of care? Can I receive care from Enloe Medical Center anyway?
If you elect to receive non-emergency care at Enloe Medical Center, its other facilities or practices, you will likely be responsible for significant out of pocket expenses which are not credited to out of pocket maximums.
Network physicians that admit patients to Enloe Medical Center will be informed about the contract termination so that members will be admitted to participating network facilities following the contract's termination date. Click here to search for alternative network facilities*. *While Anthem makes every effort to ensure that the lists of doctors and hospitals are up to date and accurate, providers like Enloe do leave the network from time to time, and the listings need to be changed. Updating the provider lists are done as quickly as possible but there can be a time when a provider shows up that should no longer be listed. If there are any questions about a provider being in the Anthem network, calling the provider directly and having their office confirm the current most up to date status would be the most effective course of action. If I do not have access to an alternate participating provider or a particular service is not available elsewhere, can I receive that service from Enloe Medical Center?
Anthem Blue Cross assures you will have timely access to care. If a service is not available at an alternate participating provider, you may request an out-of-network referral by contacting Customer Service/Coastal at 800-564-7475. Requests will be reviewed on a case-by-case basis pursuant to the Anthem Blue Cross out-of-network referral policy. When an out-of-network referral is approved by Anthem Blue Cross, your in-network benefit levels will apply.
However, because Enloe Medical Center no longer participates in the Anthem Blue Cross provider network, you may be responsible for higher out of pocket expenses for Enloe services. Every effort will be made to assist you in understanding the potential financial consequences of the decision to seek services from a non-participating provider. What if I need emergency medical care at Enloe Medical Center after December 31st?
A hospital's emergency medical services do not require pre-authorization, regardless of where they are delivered. Enloe Medical Center must continue to provide services for members requiring emergency care (1). Coverage will be provided according to the member's policy benefits. (2).
Anthem Blue Cross encourages members to make informed decisions about when to use urgent care as opposed to emergency room care. Urgent care is appropriate when a member needs a physician's attention for a condition that is non-life threatening. Any member needing urgent care, but whose physician or network provider is unavailable, should go to the nearest immediate or urgent care facility. (1) Emergency or Emergency Medical Condition means a medical or behavioral health condition manifesting itself by acute symptoms of sufficient severity including severe pain such that the absence of immediate medical attention could reasonably be expected to result in any of the following:
An emergency medical condition includes a psychiatric emergency medical condition, which is a mental disorder that manifests itself by acute symptoms of sufficient severity that it renders the patient as being either of the following: a) an immediate danger to himself or herself or to others, or b) immediately unable to provide for, or utilize, food, shelter, or clothing, due to the mental disorder. (2) *Emergency care is covered at a reasonable charge (also known as an allowed amount), which is not the same as an in-network rate. The member will be responsible for his/her deductible and coinsurance limits, based on the allowed amount of charges, which will be applied to the out of pocket maximum. Enloe may bill the member for the balance of charges in excess of the allowed amount and such amounts will not be applied to the members out of pocket maximum. NOTE: Members do have the right to request for the provider and/or facility to write off any excess charges above the allowed amount. where can i go for in-network treatment?
Life-threatening emergency: Go to the nearest emergency room, including Enloe. (See FAQ "What if I need emergency care at Enloe Medical Center after October 31st?" for important information on the costs associated with emergency care at Enloe. )
Not a life-threatening emergency: Oroville Hospital remains in network and can provide other emergency care. Adventist Health Feather River (Paradise) is still a network provider, but is not available for patient care at this time. Lacerations and orthopedic fractures: Immediate Care (Chico and Paradise) Other urgent and episodic needs, as well primary and preventive care: BSSP's Health and Wellness Centers (Chico 879-7438 and Oroville 532-5918) Specialty Practices: Click here for the Anthem Provider Search tool*. *While Anthem makes every effort to ensure that the lists of doctors and hospitals are up to date and accurate, providers like Enloe do leave the network from time to time, and the listings need to be changed. Updating the provider lists are done as quickly as possible but there can be a time when a provider shows up that should no longer be listed. If there are any questions about a provider being in the Anthem network, calling the provider directly and having their office confirm the current most up to date status would be the most effective course of action. How much does anthem profit on bssp's membership?
It is important for you to know that Enloe's recent statements about Anthem profiting at the expense of Enloe and our community are not accurate with regard to your BSSP coverage.
Through SISC, BSSP provides self-insured medical benefits on a non-profit basis. Premiums are set at rates necessary to cover the cost of claims and provider network administration, only. SISC's only payment to Anthem is a flat administrative fee per BSSP employee/ retiree per month. Payments to Enloe for your claims have no bearing on Anthem profits. Anthem is negotiating on behalf of all Anthem subscribers (excluding those covered by Medicare and Medi-cal), not just those covered through BSSP+SISC. Most local public agencies are participating in self-insured medical benefits on a similar non-profit basis. Employees, retirees and their dependents covered through non-profit self-insured plans represent a substantial share of our community. On behalf of BSSP+SISC members, Anthem is effectively negotiating for public school dollars. When we pay health care providers more for services, districts and their employees will pay more for coverage. Public schools are already underfunded and every additional dollar we pay to a provider is one less dollar for public education. Here's how the average BSSP employee's medical premium of $1075/month (both employee and employer share, combined) is spent: $519 Medical facility claims (impacted by Enloe rate increases) $256 Medical professional claims (impacted by Enloe rate increases) $192 Prescription claims $ 53 Health and Wellness Center operations $ 37 Anthem claims processing, network access, etc. $ 8 BSSP+SISC administration $ 6 Value-added services $ 4 Prescription administration 
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