Anthem Managed Care Update
Anthem Blue Cross Blue Shield Contract Negotiation Update
Southwest General is committed to providing high-quality, accessible care for our community. As part of that commitment, we are currently in contract negotiations with Anthem Blue Cross Blue Shield (BCBS) for both Commercial and Medicare Advantage plans. While discussions are ongoing and progressing in good faith, Anthem members may be considered out of network at Southwest General beginning January 1, 2026, if a new agreement is not reached.
What This Means for Anthem Members
If a new contract is not finalized:
- Anthem BCBS Commercial and Medicare Advantage members will be out of network starting January 1, 2026 (hospital, provider and ancillary services)
- You may face higher co-pays or co-insurance for services received at Southwest General
- You can continue using your Southwest General providers, but your cost share may change based on your plan’s out-of-network benefits
Review Your Options During Open Enrollment
As you make health insurance decisions—whether during Medicare Open Enrollment (now through December 7, 2025) or your employer’s annual enrollment—please keep this information in mind if staying in-network with Southwest General supports your ongoing care needs.
If you are choosing employer-sponsored coverage, consider encouraging your employer to offer additional plan options beyond Anthem so you can remain in network with Southwest General.
Questions About Your Coverage?
For information about your specific benefits, contact Anthem BCBS directly using the number on the back of your insurance card.
Our Commitment to You
We understand how important it is to have reliable access to your preferred providers and services. Southwest General remains focused on keeping our community informed as negotiations continue and ensuring you receive the care you depend on.
Frequently Asked Questions
Q. Why is Southwest General negotiating with Anthem Blue Cross Blue Shield?
A. Southwest General’s insurance contracts are established for set
periods of time. When a contract term ends, we review and renegotiate
the agreement to ensure the updated terms accurately reflect the rising
costs and administrative requirements of delivering high-quality health care.
Our current agreement with Anthem has reached the point where updated terms are needed, and we are actively working in good faith with Anthem to establish a new contract for both Commercial and Medicare Advantage plans.
Q. What is changing?
A. If a new agreement is not reached, Anthem Commercial and Medicare Advantage
members will be considered out of network at Southwest General beginning
January 1, 2026. This may impact your out-of-pocket costs for care received
at Southwest General.
Q. How will this affect my relationship with my Southwest General doctors?
A. You can continue seeing your Southwest General providers, even if Anthem
becomes out of network. However, your co-pays, co-insurance or deductibles
may increase depending on your plan’s out-of-network benefits.
Your relationship with your doctor is important—and we are here to help you explore options that keep your care affordable.
Q. How will being out of network affect my costs?
A. If Anthem becomes out of network, your care at Southwest General may
result in:
- Higher co-pays or co-insurance
- A separate out-of-network deductible
- Changes in coverage for certain services
Your exact costs depend on your specific Anthem plan. Call the number on the back of your card for details.
Q. What options do I have during Medicare Open Enrollment?
A. From now through December 7, 2025, Medicare-eligible patients can adjust
their coverage. If you want to maintain in-network access to Southwest
General, you may:
- Switch to Traditional Medicare, which will continue to cover Southwest General services
- Enroll in a Medicare Advantage plan that remains in network with Southwest General
Q. What if I get my Anthem Medicare Advantage plan through a retiree or pension program?A. Some retiree and union plans offer the same benefits for both in- and out-of-network services. If this applies to your plan, your out-of-pocket costs at Southwest General may not change, even if Anthem becomes out of network.
Since each plan is different, we encourage you to:
- Check with your plan administrator, or
- Email us your plan details at InsuranceQuestions@swgeneral.com so we can help you review your benefits.
Q. Who should I contact for help reviewing my insurance plan options?
A.
If you have commercial insurance, we encourage you to reach out to your employer’s benefits administrator
for more information about your plan or available options.
If you have a Medicare Advantage plan, we can help connect you with a licensed insurance broker who can review plans and answer your questions.
For additional information or questions, contact us at: InsuranceQuestions@swgeneral.com.
Q. Where can I find information on available licensed insurance brokers?
A. Many local brokers are licensed to assist patients with Medicare enrollment.
For convenience, here is a list of brokers who have worked with patients
in our service area. Inclusion on this list does not constitute an endorsement
or recommendation by Southwest General Health Center. Patients are free
to choose any licensed broker.
Shelley A. Chornak – Sage Partners
7251 Engle Rd., Suite 103
Middleburg Heights, OH 44130
216-525-5956
www.sage-partnersllc.com
Larry Riddell Insurance
490 Cleveland St., Elyria, OH 44035
440-309-8498
https://riddellinsurance.com/contact/
KAZ Company
4807 Rockside Rd., Suite 660, Independence, OH 44131
216-901-9300
https://medicareplansneo.com/
Q.
When would this change take effect?
A. If no agreement is reached,
Anthem members will become out of network on January 1, 2026. Until that date, Southwest General will remain in network for Anthem
Commercial and Medicare Advantage plans.
Q.
I still have questions. Who can I contact?
A. We’re here to help.
- Call: 440-817-1225
- Email: InsuranceQuestions@swgeneral.com