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What is the status of Anthem and Stanford negotiations?

Stanford Hospital and Lucille Packard Children's Hospital (collectively "Stanford") have issued a notice of termination to Anthem Blue Cross effective September 1, 2019.

What's next?  We are hopeful that Anthem and Stanford will continue to negotiate towards a fair and reasonable contract with Stanford as a network provider.   
  • Watch your email!  BSSP will continue to keep you updated as we receive pertinent information regarding Stanford's status under the Anthem network. 
  • Review  the FAQ's to the right of this text. 
  • If your question isn't answered there, please reach out to BSSP at 530-879-7438 or via email at bssp@bsspjpa.org.   

If Stanford and Anthem Blue Cross do not come to an agreement by midnight on September 1, 2019, Continuity of Care will begin September 1, 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.
 
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 termination date, it is best to start the application process prior to the termination on September 1, 2019.
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​Contact Member Services/Coastal (800-564-7475) immediately to discuss continuity of care options if you are a Stanford patient and:
  • Are in an active course of treatment for an acute medical or behavioral health condition;
  • Are in an active course of treatment for a serious chronic condition;
  • Are pregnant, regardless of trimester;
  • Have been diagnosed with a terminal illness;
  • Have a newborn child (being seen by a Stanford provider) between the ages of birth and 36 months; or
  • Have a surgery or other procedure that was authorized by Anthem Blue Cross prior to the contract expiration date and is already scheduled to occur within 180 days after the termination date.  
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.  

Due to the volume of members impacted (remember, this is all of Anthem --- not just BSSP) by Stanford'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 Stanford must also agree to the Continuity of Care provisions on a case-by-case basis.  
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See more FAQ's on the box on the right side of this page.

Frequently Asked Questions 

what if i am in-patient at stanford 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 Stanford 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 AT stanford AFTER THE CONTRACT TERMINATION DATE?
If you began a course of treatment at Stanford before September 1 for one of the following conditions, you 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:
  • 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 Blue Cross prior to the termination date and scheduled to occur within 180 days after the termination date.
Eligibility for continuity of care depends on many factors and continuity of care/completion of covered-services will be considered by the Anthem Blue Cross Transition Assistance Department on a case-by-case basis. When a case is approved, the claim is processed at in-network benefit levels. ​

​Due to the volume of members impacted (remember, this is all of Anthem --- not just BSSP) by Stanford'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 Stanford 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 stanford ANYWAY?
If you elect to receive non-emergency care at Stanford, 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 Stanford 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 Stanford 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 stanford?
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 Stanford may no longer participate in the Anthem Blue Cross provider network, you may be responsible for higher out of pocket expenses for Stanford 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 STANFORD AFTER SEPTEMBER 1ST? 
A hospital's emergency medical services do not require pre-authorization, regardless of where they are delivered.  Stanford 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:
  • Placing the patient’s health or the health of another person (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;
  • Serious impairment to bodily functions; or
  • Serious dysfunction of any bodily organ or part.
 Emergency includes being in active labor when there is inadequate time for a safe transfer to another hospital prior to delivery, or when such a transfer would pose a threat to the health and safety of the member or unborn child.
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.
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(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.  Stanford 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.
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