Frequently Asked Questions

Q: Why is the Anthem Blue Cross agreement in jeopardy of termination?

A: Anthem Blue Cross is a for profit health insurance plan. While the cost of your insurance premium, paid for by your employer and/or you, continues to escalate and the cost of providing health care services continues to escalate, Anthem is not willing to increase its contractual payment to Southwest General (SWG) to sufficiently cover the rising cost of the healthcare services provided. To date, Southwest General has not been able to reach agreement with Anthem for all patients with an Anthem Commercial Health Plan or an Anthem Medicare Advantage Plan. This does not affect patients with an Anthem Medicare Supplement Plan.

Q: Anthem Blue Cross is my health plan. How does the contract negotiation impact me?

A: Negotiations between Anthem Blue Cross and SWG have been ongoing since 2021. If an agreement cannot be reached by the current contract termination date at midnight on January 1, 2023, SWG will be “out-of-network” for all patientsfor non-emergency care with an Anthem Commercial Health Plan or an Anthem Medicare Advantage Plan.

Q: How does “out of network” impact my access to healthcare services provided by Southwest General Hospital?

A: If termination occurs, on or after January 1, 2023, Southwest General inpatient and outpatient services will no longer be contracted with Anthem. This means you may no longer have in-network benefits and may have higher patient out-of-pocket amounts like copays and deductibles. You may continue to access our Hospital for health care services as follows:

• Emergency Care: Emergency care access is not impacted. You may continue to receive emergency care at our Emergency Departments, regardless of our network status with Anthem.
• Physician Visits: Physician contracts are not impacted. You may continue to receive care from all your physicians at Southwest General. This includes all hospital based physician groups like radiology and emergency groups--- all remain in-network with Anthem.
• Home Health/Hospice/ Home Infusion: These services are not impacted. You may continue to receive this care and it remains in-network for all Anthem patients.
• Continuity of Care: Some patients may be eligible to receive “Continuity of Care” benefits from Anthem for a period of time. These patients often need ongoing care or treatment, are pending an obstetric delivery, or already have a procedure authorized and scheduled. For questions about ongoing care or your benefit coverage, please call the phone number listed on the back of your Anthem Blue Cross insurance card.
• Out-Of-Network Care: You may still access our health care providers and Hospital for health care services if you have an out-of-network benefit. In some situations, depending on the type of service Anthem authorizes, in-network benefits may be available if alternative providers are not available in the service area. Please call the number listed on the back of your insurance card to discuss your specific in or out-of-network benefits with Anthem.

Q: Can I still see my doctor? Are physician groups included in this issue?

A: This negotiation does NOT affect Southwest General Medical Group; our many independent physicians; or our hospital-based physician groups like anesthesia, neonatology, pathology, radiology and emergency. All physicians who are currently contracted with Anthem will remain contracted and in-network with Anthem.

Q: Will I have to pay more to receive care if Southwest General becomes an out-of-network provider?

A: Please call Anthem Customer Service with the number listed on the back of your insurance card to discuss your specific in or out-of-network benefits with Anthem. Southwest General also offers self-pay and prompt payment options. Additional information regarding this can be found on our website at www.swgeneral.com under the “Financial Tools” section.

Q: What happens if I’m in the hospital already on January 1? Or I need my scheduled chemotherapy treatment? Or I’m pregnant and I’m due to deliver soon?

A: We want you to keep your physician and care team and do not want this to cause additional stress or anxiety during this time. Under federal law, Continuity of Care Anthem must allow coverage and care for patients who are:

1. Undergoing treatment for a serious and complex medical condition.
2. Undergoing inpatient or institutional treatment.
3. Scheduled to undergo non-elective surgery, including receipt of postoperative care with respect to such a surgery.
4. Pregnant and receiving treatment related to the pregnancy.
5. Terminally ill per the Social Security Act and receiving treatment for the terminal illness.

Your care (and the care of your baby if delivering at SWG) will be still covered no matter what and at the same out-of-pocket amounts as your current in-network amounts (e.g. deductible, coinsurance, etc).

Q: What if I have a medical appointment, plan on delivering my baby or elective procedure scheduled on or after January 1, 2023?

A: We understand you may already have appointments scheduled on or after January 1, 2023. If this is the case, you may qualify for Continuity of Care benefits. Contact Anthem Customer Service using the phone number on the back of your health insurance card to learn more about your Continuity of Care benefit coverage.

Q: How long will Southwest General be an out-of-network provider? And can I help show my support?

A: At this time, it is difficult to determine how long we may be out of network. We have kept the lines of communication open with Anthem. We recognize and value our relationship with our patients and remain open to discussions with Anthem toward a mutually beneficial agreement. Please feel free to contact your benefits manager or Anthem directly (800) 676-2583 to express your concern about having to leave the community to access health care services.

Q: If I want to switch my Medicare Advantage Plan, with which plan(s) does SWG contract?

A: Southwest General proudly contracts with any willing Medicare Advantage plan. Members should work with a healthcare insurance agent or research similar plans available through Aetna, CIGNA, Devoted, Humana, Medical Mutual, Wellcare, and United Healthcare. A complete list of contracted plans can be found on our website. If patients need help and do not have an insurance agent, we have provided a list on our website of broker partners who can help.

There is also Open Enrollment: MA patients can change their Advantage plan to another plan starting January 1 and through March 31. Please speak to an insurance agent on how this works.

Q: I have an Anthem Medicare Advantage plan and I received a letter this week from Anthem. What does this mean for me?

A: Medicare requires Medicare Advantage plans to notify their members by 30 days with any changes to their network. For members with a HMO Medicare Advantage, non-emergency care may have a higher out-of-pocket cost. For most PPO members, benefits will not change because your plan covers both in-network and out-of-network services at the same member cost share difference. Regardless of the product, Southwest General is prohibited from balance billing Medicare Advantage members. Members are encouraged to check their benefits details in their plan documents. Affected Members who are not willing to risk being out-of-network, may change plans to another Medicare Advantage plan through December 7.