|Anthem and Hospital Corporation of America ("HCA") have been engaged in active commercial contract negotiations for several months following HCA's decision to issue a termination notice, effective March 3, 2012. Unfortunately, despite Anthem's good faith negotiations and requests to extend the date of termination so as to avoid disruption in care for Anthem members, HCA terminated its agreement, effective March 3, 2012. HCA includes the following hospitals located in Santa Clara, Ventura, Los Angeles and Riverside counties:
- Good Samaritan Hospital-San Jose
- Regional Medical Center of San Jose
- Riverside Community Hospital
- Los Robles Regional Medical Center
- West Hills Hospital
Anthem is very disappointed that HCA has decided to terminate its agreement, which has produced profit margins for HCA of approximately 35%.
Immediately following HCA's termination, and consistent with legal/regulatory requirements related to member notification, Anthem mailed letters to fully-insured PPO members enrolled in DMHC-regulated and CDI-regulated health plans who reside within 15 miles of an HCA hospital telling them about the termination. Anthem also mailed letters to Healthy Families EPO, AIM EPO, and MRMIP members who reside within 15 miles of an HCA hospital. The letters instruct members to call the Customer Service number on their ID card if they are in a current course of treatment at a terminating hospital or have questions or concerns about the contract termination.
Notices were also sent to agents, brokers and clients affiliated with the DMHC-regulated membership receiving notice of HCA's termination. PPO physicians and HMO medical groups that admit to the terminated hospitals were notified as well.
Anthem Blue Cross realizes that there may be continuity of care concerns for members. 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. Anthem offered a rate of payment to HCA for completion of covered services/continuity of care. HCA rejected Anthem's request to execute a continuity of care agreement, which would have extended care for our sickest and most vulnerable members currently receiving care at HCA hospitals.
In an effort to assist Anthem members who have been placed in this unfortunate situation by HCA, Anthem is honoring authorized/scheduled services at the hospitals for the month of March to ensure members receive the care they need in a timely manner during this transition. HMO members wishing to request services at an HCA hospital following the termination should contact their assigned medical group/IPA. PPO members who want to request care at an HCA hospital following the termination should call the Customer Service number on their membership ID card. Requests will be reviewed by Anthem's clinical staff and, if approved, members' in-network benefit levels will apply. However, it is important to note that because the hospitals are no longer in Anthem's hospital network, members may be responsible for higher out of pocket expenses, depending on their benefit plan/evidence of coverage. Every effort will be made by Customer Service and the clinical staff in Anthem's Transition Assistance Department to assist the member in understanding the potential financial consequences of their choice to go to an HCA hospital.
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