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

Update: 4/10/24

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It is with deep disappointment that we must inform you of Anthem Blue Cross Blue Shield's decision to remove us from their network of healthcare providers, effective April 1, 2024. This means that Sauk Prairie Healthcare is no longer in-network for Anthem Blue Cross Blue Shield health plans. (Please note: Prairie Clinic continues to be in-network with Anthem.)

This outcome is not what we desired. Despite our sincere efforts to negotiate a fair agreement, Anthem remained steadfast in their position, which did not adequately consider the rising costs of labor, supplies, and medicine needed to provide quality, high-value care.

At Sauk Prairie Healthcare, our commitment lies with you — our patients and community. We understand the significant impact this decision will have on your ability to access the care you need. Unlike large national insurance companies like Anthem, we are deeply rooted in this community. We shop in the same stores, our children attend the same schools, and we share in the same joys and challenges as you.

As a community-focused, not-for-profit health system, we understand the stress and inconvenience this situation may cause as you navigate finding alternative healthcare providers and possibly traveling further for care. Please know that we will continue to work diligently to reach an agreement with Anthem in the future that gives you value and prioritizes your well-being.

>>Click here to read our message to the community.

Please see below for answers to some commonly asked questions. If your question is not addressed below, please call the special phone number we have set up so that we can connect you to the best person to answer your questions. Call 608-643-4111 and leave a message; our team will respond to you as quickly as possible.

Frequently Asked Questions

Updated 4/1/24

What Anthem members are impacted?
According to Anthem’s website, www.anthem.com/saukprairie , “This could affect the out-of-pocket obligations for Anthem members enrolled in Blue Preferred / Blue Preferred Plus (HMO/POS); Blue Access (PPO); Blue Priority and Blue Priority-X; Blue Traditional; Medicare Advantage (HMO/PPO); and Medicaid health benefit plans and receive non-emergency care at Sauk Prairie facilities. Note that some Anthem members may have out-of-network benefits. We encourage all members to review and become familiar with their health plan’s Evidence of Coverage (EOC) booklet for the exact terms and conditions of coverage.”

Which other insurance plans include Sauk Prairie Healthcare in their provider network?
Sauk Prairie Healthcare accepts most commercial insurance plans and HMOs, including: Quartz, Dean, The Alliance, and GHC-SCW, and many more. If you have questions about an insurance not listed here, please call 608-643-4111.

How can patients seek “continuation of care” with Sauk Prairie Healthcare?
According to Anthem's website, if you're receiving treatment for a serious or complex condition with that will continue past March 31, 2024, you should contact their Member Service Center at the number on your Anthem ID card.

It is our understanding that Anthem enrollees may be granted the ability to continue in-network care with Sauk Prairie Healthcare for up to 90 days in certain circumstances, such as: in treatment for a serious or complex condition; in the hospital; scheduled for non-elective surgery; pregnant; or terminally ill. If this is your situation, Anthem's Member Service Center should be able to provide you with the appropriate paperwork to request continuation of care.

While it is Anthem's process that needs to be followed to request continuation of care, to the best of our knowledge we think that process includes the patient completing Anthem’s Provider Termination Continuity of Care Form https://www.anthem.com/docs/public/inline/1042164MUMENABS.pdf and mailing or faxing it to the Anthem location directed in the form. The patient would be notified by Anthem if their continuation of care is approved.

What should I do if I have an upcoming appointment at Sauk Prairie Healthcare?
We are cancelling appointments for patients who have Anthem Blue Cross Blue Shield as their primary insurance. We are contacting those patients to make them aware of the cancellation and further explain the process to follow if they still want to be seen. Those patients may also call us at 608-643-4111.

I see a provider at Prairie Clinic. Are they in Anthem BCBS’s network?
Yes, Prairie Clinic is in-network for Anthem BCBS.

Are the UW Health and SSM Health clinics which are located at the Sauk Prairie Healthcare Campus in-network with Anthem?
UW Health and SSM Health’s network status with Anthem are not impacted by this situation. UW Health and SSM Health are not affiliated with Sauk Prairie Healthcare.

My Medicare Supplement is through Blue Cross Blue Shield. Will Sauk Prairie Healthcare be out-of-network for me?
Medicare Supplement Insurance (Medigap) is extra insurance you can buy from a private health insurance company to help pay your share of out-of-pocket costs in Original Medicare. According to Blue Cross Blue Shield’s website https://www.bcbs.com/medicare/medigap, “most of the time, Medigap coverage has no network limitations and is available anywhere that Medicare is accepted.” To verify that your BCBS Medicare supplement insurance has no network limitations, call the number on the back of your insurance card or check with your insurance agent.

I have a Blue Cross Blue Shield secondary plan. How does this affect me?
Any balances left after your primary insurance company pays would be sent to Blue Cross Blue Shield for processing. Anthem BCBS has several types of health plans, so out-of-network benefit coverage varies. To verify your out-of-network benefit, contact BCBS at the number of the back of your insurance card.

I get insurance through my employer. Is it too late in the year for me to switch insurance plans?
It depends. If an alternate health plan is available to you through a spouse or partner’s employer, check with their human resources representative to see if this situation is a qualifying event that would enable you to enroll at this time. Sauk Prairie Healthcare is in-network for most commercial insurance plans and HMOs, including Quartz, Dean, GHC-SCW, however, individual plans vary, so be sure to confirm that Sauk Prairie Healthcare is in-network.

If I want to continue to receive out-of-network care at SPH, what are my payment options?
Each situation is unique to you and your health plan. Our Pre-encounter team is happy to provide a price estimate so that you understand your options. Call 608-643-4111 to request an estimate.

Sauk Prairie Healthcare offers a Financial Assistance Program for those individuals and services that qualify. If you would like to learn more about our Financial Assistance Policy, please visit our website at https://www.saukprairiehealthcare.org/patients-visitors/billing/financial-assistance/

How do I voice my concern to Anthem?

• Call Anthem or your health plan at the number on the back of your Anthem identification card. Tell Anthem that you want Sauk Prairie Healthcare to be in-network.
• If you have employer-sponsored health insurance, talk to your employer and/or human resources representative about your need for in-network access to Sauk Prairie Healthcare’s services and providers. Ask them to encourage Anthem to include Sauk Prairie Healthcare as an in-network provider for your plan.

Will Anthem cover emergency care at Sauk Prairie Healthcare?
According to Anthem’s website, even if Sauk Prairie Healthcare is not in-network, “emergency medical services do not require pre-authorization, regardless of where they are delivered. Anyone in need of emergency care should immediately go to the nearest emergency room or call 9-1-1. Coverage will be provided according to the member’s policy benefits and in-network cost shares.” However, we think it’s important for you to know that Urgent Care (which is also offered within Sauk Prairie Healthcare’s Emergency Department) is not considered emergency care and will likely result in higher out-of-pocket costs.

Why wasn’t I notified?
Patients purchase insurance coverage from Anthem BCBS. If Anthem changes the terms of their coverage, state law requires Anthem to notify their enrollees of the change. If you did not receive a notification from Anthem, we’d encourage you to ask Anthem why.

SPH has been contacting (and continues to contact) patients with Anthem insurance who have appointments scheduled after April 1 to let them know they may not be covered. We have also posted a notification on our website, in our clinics and hospital, emailed through our MyHealth patient portal, and mailed a letter to those patients we believe to have Anthem as a primary insurance.

Why won’t you accept Anthem’s proposal?
Despite our efforts to negotiate a fair agreement, Anthem remained steadfast in their position, which did not adequately consider the rising costs of labor, supplies, and medicine needed to provide quality, high-value care.