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

Effective April 1, 2024, 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.)

Please see below for answers to some commonly asked questions.

Frequently Asked Questions

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 608-643-7190.

How can patients seek “continuation of care” with Sauk Prairie Healthcare?
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 from 4/1/24 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 and 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 608-643-7528.

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 608-643-7528 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/

Will Anthem cover emergency care at Sauk Prairie Healthcare?
According to Anthem’s website, “Emergency medical services are not impacted. 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.