As of July 16, 2021, Dignity Health excommunicated Anthem Blue Cross of California from their provider network. In other words, Blue Cross is no longer an in-network provider with Dignity Health. The split between Dignity Health and Blue Cross revolves around contract negotiations focused how much Blue Cross will reimburse Dignity Health for health care services.
For Blue Cross members in EPO plans, that have no out-of-network coverage, this poses a particular challenge. The disruption to Dignity Health patients with Blue Cross insurance is even worse if the patient is undergoing treatment for an illness. Because Blue Cross EPO plans – which includes Covered California – serve much of rural Northern California, it may be a challenge to find another doctor in parts of California if Dignity Medical Group doctors are not available.
Dignity Health Starts To Terminate Anthem Blue Cross
Communication from Dignity Health states they are presenting solutions to the contract impasse. However, Dignity paints Anthem Blue Cross as intransigent in accepting some higher reimbursement costs for health care services. Anthem Blue Cross has been oddly quiet on the excommunication that affects thousands of individuals and families across California.
Anthem Blue Cross health plans affected by the Dignity Health schism are Dignity hospitals for commercial HMO, EPO, PPO, and POS health plans, some Medicare Advantage plans, Medi-Cal HMO, Workers Comp plans. Also, out-of-network are Dignity Health Medical Foundation physicians and hospital-based clinics for commercial PPO, EPO health plans, Medicare Advantage and Workers Comp.
Some Blue Cross members will continue to access Dignity Health services for a limited time.
- Medicare Advantage plan members where the Blue Cross member is linked to a Mercy Medical Group or Woodland Clinic.
- Medi-Cal HMO members will still be able to access some of the Dignity Health hospitals such as Mercy San Juan, Mercy General, Mercy Folsom, California Hospital Med Center, Glendale Memorial, Northridge Hospital Med Center, and St. Mary Long Beach. Dignity Health Physicians at hospital-based clinics will still be in-network.
Medicare Supplements: if you have a Anthem Blue Cross Medicare Supplement plan, nothing should change. Dignity Health bills Medicare and the Blue Cross Supplement covers some or all of the member cost-sharing for the health care service.
The calendar of events on the Keep Dignity Health website states that by October 17, 2021, all Dignity providers and hospitals will be out-of-network with Anthem Blue Cross. The contract termination would include Medicare Advantage plans and other HMO groups. The complete termination with Blue Cross assumes that there will be no resolution to the contract dispute. Dignity Hospitals will still be in-network for life-threatening emergency care.
Because of the confusing inter-connected relationship between doctor medical groups and hospitals, it is always best to call your doctor, if they are affiliated with Dignity Health, to make sure they are still in-network for your health plan.
Anthem Blue Cross Update July 26th
Anthem Blue Cross has stated that it is their intention to reach an contract agreement by August 1, 2021. For Medicare Advantage members, only the Dignity hospitals have been terminated as in-network. Doctors in QualCare/GemCare will be terminated on August 1st, if a contract has not been reached. Anthem has closed PCP assignment for physicians in the Dignity network. However, some of the physicians in the Dignity network are also covered by other medical group networks. It is just a matter of changing the PCP number to a different group in order to retain the services of the doctor. Anthem also has a list of alternative hospitals that can be used in place of Dignity hospitals.
If a health care provider loses network status and you are in the middle of treatment, you can apply for continuity or transition of care from Anthem Blue Cross.
If approved by Anthem Blue Cross, you can continue to received treatment from your Dignity Health providers until your course of treatment has concluded. This unfortunately puts the burden on the patient when two mega corporations are squabbling over money.
Blue Shield of California gets into contract negotiation cat fights with Sutter Health every couple of years. In the past, those brawls are resolved in a couple of weeks and everything goes back to normal. Let’s hope the Dignity – Blue Cross lover’s quarrel will end soon.