Important to Notice for Patients with Anthem Blue Cross Blue Shield Insurance

Update October 9, 2025 — Sauk Prairie Healthcare and Anthem Blue Cross Blue Shield have reached a 3-year agreement providing Anthem members with in-network access to Sauk Prairie Healthcare’s hospital, clinics, and providers. The contract is effective January 1, 2026, meaning services provided on or after this date will be covered as in-network.

“We’re looking forward to once again being in-network to serve our patients who have Anthem insurance,” said Shawn Lerch, Sauk Prairie Healthcare CEO. “This renewed partnership reflects our shared commitment with Anthem to ensure that our community has access to the high-quality healthcare services they need.”

Please see below for answers to some commonly asked questions.

Frequently Asked Questions

What date should patients expect in-network billing to apply?
In-network coverage applies to services provided on and after January 1, 2026.

Will past services be retroactively covered in-network?
No. Claims are processed based on your benefit status on the date of service. Prior services or any service rendered prior to January 1, 2026 will be out-of-network and will not be retroactively covered by Anthem as in-network.

Can I schedule an appointment now for after January 1, 2026.
Yes!

I have an upcoming appointment — what should I do?
If your appointment is on or after January 1, 2026, you’ll be in-network. If not, you may:

• Keep the appointment and elect to be self-pay. A price estimate will be provided. Full payment is required before the appointment.
• Reschedule to a date on or after January 1, 2026.

I’m due to deliver my baby after January 1, 2026 and want to deliver at SPH. What happens if I deliver early?
If you have Anthem insurance, your insurance claim will be processed as out of network. If you’d like to deliver at SPH prior to January 1, 2026, you can elect to be self-pay. Full payment is required before your delivery.

Will Emergency Department and Urgent Care be covered in-network?
Under the No Surprises Act, emergency care is covered at in-network levels. However, Urgent Care will be treated as out-of-network until January 1, 2026.

How can I understand my costs?
Coverage and cost-sharing vary by plan and date of service. For a personalized estimate, contact our Pre-Encounter team at 608-643-7528. Financial assistance remains available for those who qualify.

Which Anthem plans are included?
Anthem offers multiple plan types. Most members will regain in-network access through this agreement, but benefits can vary by product or network. Always verify with Anthem using the number on your insurance ID card.

How will SPH communicate updates?
We’ll share updates on our website at www.SaukPrairieHealthcare.org/Anthem

What changed to allow an agreement now?
Both organizations worked to balance affordability for members and sustainability for community care. With a signed agreement, we can restore local access while managing costs responsibly.